Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study

Frost, Rachael; Jovicić, A; Liljas, Ann; Iliffe, Steve; Manthorpe, Jill; Gardner, Benjamin; Avgerinou, Christina; Goodman, Claire; Drennan, Vari; Walters, Kate

doi:10.1111/hsc.12526

Cited by 25 publications

(37 citation statements)

References 41 publications

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“…23,24,38 Models of home support should, therefore, reflect this complexity, and address cognitive and physical dependency as highlighted in this study, including a broader range of personalised supports for social isolation, mental health, cultural, and personal aspects. 37,[39][40][41][42] This approach has been recommended by the WHO. 2 A strength of this study is the large sample size.…”

Section: Discussionmentioning

confidence: 99%

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Aspell

O’Sullivan

O’Shea

et al. 2019

Int J Geriat Psychiatry

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Objective To identify factors that predict admission to long‐term care (LTC) and mortality among community‐based, dependent older people in Ireland, who were in receipt of formal home support. Methods An audit was conducted of all community‐dwelling older adults receiving government funded home support during 2017 in the Dublin North Central, Health Service Executive administrative area. Data were extracted from the Common Summary Assessment Report (CSAR), a mandatory form used in the provision of home support. Multiple logistic regression analysis was used to examine the factors associated with admission to LTC and mortality, with the results presented as odds ratios (OR) and 95% confidence intervals. Results The audit comprised 1597 community‐dwelling older adults with a mean age of 83.3 (SD: 7.2) years. The prevalence of transition to LTC and mortality was 8% and 9%, respectively, during the 12‐month period. Factors significantly associated with admission to LTC were “cognitive dysfunction” [OR 2.10 (1.41‐3.14), P < .001] and the intensity of home support [OR 1.05 (1.01‐1.06), P < .003], as measured by weekly formal care hours. Physical dependency and advanced age (aged 95 years +) were significantly associated with mortality in this population (P < .001). Conclusion “Cognitive dysfunction” and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. Investment in personalised, cognitive‐specific, services and supports are necessary to keep people with dementia and related cognitive impairments living at home for longer.

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Section: Discussionmentioning

confidence: 99%

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Aspell

O’Sullivan

O’Shea

et al. 2019

Int J Geriat Psychiatry

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“…In our development work, qualitative interviews with older people, carers and health professionals revealed that a health promotion service should cover a broad range of domains, and use mechanisms such as providing information and signposting, emotional and practical support, and boosting motivation (Frost et al, ; ). Although the COM‐B model (Michie et al, ), which underpinned the design of HomeHealth, has been increasingly used for behaviour change health promotion across different disciplines, few studies explore older people's experiences with this approach, and it is the first to focus on people who are mildly frail.…”

Section: Discussionmentioning

confidence: 99%

Health promotion for mild frailty based on behaviour change: Perceptions of older people and service providers

Avgerinou

Gardner

Frost

et al. 2019

Health Soc Care Community

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Mild frailty is common among older people, but it is potentially reversible with health promotion interventions. Behaviour change may be a key to preventing progression of frailty; however, we know little about what interventions work best and how a behaviour change approach would be perceived by this group. The aim of this study was to explore how mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach. We conducted semi‐structured interviews with 16 older people with mild frailty who received a pilot home‐based behaviour change health promotion service, including a dyad of older person/family carer, and two service providers delivering the service in two diverse areas of South England. Interviews were audio‐recorded, transcribed and thematically analysed. The concept of goal setting was acceptable to most participants, though the process of goal setting needed time and consideration. Goals on maintaining independence, monitoring of progress and receiving feedback were reported to increase motivation. Physical/mental capability and knowledge/perception of own needs were main determinants of the type of goals chosen by participants as well as the approach used by the project workers. Older people with complex needs benefited from care coordination, with a combination of goal setting and elements of social, practical and emotional support in varying proportions. Mildly frail older people responded well to a behaviour change approach to promote health and well‐being. Further consideration is needed of the most effective strategies based on complexity of needs, and how to overcome barriers among people with cognitive impairment.

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“…66 Although various types of frailty intervention models have been developed and investigated, there is a considerable degree of heterogeneity in terms of optimal intervention type, sample size, population characteristic, setting, baseline frailty status, frailty definition, and outcomes, and most findings are inconclusive. [67][68][69][70][71][72][73][74] At present, it is therefore not possible to conclude what intervention is the most effective and appropriate. Overall, multi-domain intervention trials, which have been frequently conducted, 75,76 and many of which included an exercise component, seemed to have some favorable effects (although not in all trials) compared with mono-domain interventions or the control.…”

Section: Interventions For Frailtymentioning

confidence: 99%

<p>Frailty syndrome: implications and challenges for health care policy</p>

Kojima

Liljas

Iliffe

2019

RMHP

Self Cite

275

220

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Older adults are a highly heterogeneous group with variable health and functional life courses. Frailty has received increasing scientific attention as a potential explanation of the health diversity of older adults. The frailty phenotype and the Frailty Index are the most frequently used frailty definitions, but recently new frailty definitions that are more practical have been advocated. Prevalence of frailty among the community-dwelling population aged 65 years and older is ~10% but varies depending on which frailty definitions are used. The mean prevalence of frailty gradually increases with age, but the individual's frailty level can be improved. Older adults, especially frail older adults, form the main users of medical and social care services. However, current health care systems are not well prepared to deal with the chronic and complex medical needs of frail older patients. In this context, frailty is potentially a perfect fit as a risk stratification paradigm. The evidence from frailty studies has not yet been fully translated into clinical practice and health care policy making. Successful implementation would improve quality of care and promote healthy aging as well as diminish the impact of aging on health care systems and strengthen their sustainability. At present, however, there is no effective treatment for frailty and the most effective intervention is not yet known. Based on currently available evidence, multi-domain intervention trials, including exercise component, especially multicomponent exercise, which includes resistance training, seem to be promising. The current challenges in frailty research include the lack of an international standard definition of frailty, further understanding of interventions to reverse frailty, the best timing for intervention, and education/training of health care professionals. The hazards of stigmatization should also be considered. If these concerns are properly addressed, widespread application of public health approaches will be possible, including screening, identification, and treatment of frailty, resulting in better care and healthier aging for older people.

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Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study

Cited by 25 publications

References 41 publications

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Health promotion for mild frailty based on behaviour change: Perceptions of older people and service providers

<p>Frailty syndrome: implications and challenges for health care policy</p>

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