The experiences of self-care in community-dwelling older people: A meta-synthesis

Lommi, Marzia; Alvaro, Rosaria; Piredda, Michela; Marinis, Maria Grazia De

doi:10.1016/j.ijnurstu.2015.06.012

Cited by 28 publications

(24 citation statements)

References 29 publications

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“…Building on the evidence base, we were able to identify what a new service should contain and how it could best be delivered, and refine this iteratively in consultation with older people, professionals, commissioners and providers. Although previous qualitative work has canvassed older people's experiences of transitioning to frailty or general health promotion in later life, 180,182,191,192 none to date has focused specifically on older people's views of health promotion in mild frailty. We incorporated a wide range of views from a range of older people with and without mild frailty, carers, community health and social care professionals, policy-makers and commissioners and were able to make practical recommendations on the content of a new service.…”

Section: Discussionmentioning

confidence: 99%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

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Background Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. Objectives (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Design Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Intervention development Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Feasibility RCT Single-blind RCT, individually randomised to ‘HomeHealth’ or treatment as usual (TAU). Setting Community settings in London and Hertfordshire, UK. Participants A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Main outcome measures Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. Results We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Conclusions Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. Future work A large, definitive RCT of the HomeHealth service is warranted. Study registration This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

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“…shopping, gardening, crosswords) and internal processes (e.g. accepting decline and interdependency) to maintain positive well‐being (Birkeland & Natvig, ; Boggatz & Meinhart, ; D'Avanzo et al., ; Holm & Severinsson, ; Lloyd et al., ; Lommi et al., ; Menichetti & Graffigna, ; Nicholson, Meyer, Flatley, Holman, & Lowton, ; Warmoth et al., ). Our study showed that people with mild frailty, whose needs have not previously been explored, engage in similar health promotion activities and have similar motivational barriers.…”

Section: Discussionmentioning

confidence: 99%

“…Older people's views have been widely canvassed regarding self‐care, health promotion and lived experiences of frailty (Birkeland & Natvig, ; Lloyd, Kendall, Starr, & Murray, ; Lommi, Matarese, Alvaro, Piredda, & De Marinis, ; Menichetti & Graffigna, ). However, to our knowledge, no study has focussed specifically on community‐dwelling populations with mild frailty in the United Kingdom (UK), explored the acceptability of different health promotion behaviours or offered practical recommendations for designing new health promotion services.…”

Section: Introductionmentioning

confidence: 99%

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

Frost

Jovicić

Liljas

et al. 2017

Health Soc Care Community

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Mild frailty is common in later life, increasing the risk of hospitalisation, loss of independence and premature death. Targeted health promotion services may reduce adverse outcomes and increase quality of life; however, effective, well-developed theory-based interventions are lacking. We aimed to explore perceptions of health promotion behaviours undertaken by older people with mild frailty, barriers and facilitators to engagement, and identify potential components for new home-based health promotion services. We carried out 17 semi-structured qualitative interviews and six focus groups with 53 stakeholders, including 14 mildly frail older people, 12 family carers, 19 community health and social care professionals, and 8 homecare workers, in one urban and one semi-rural area of England. Transcripts were thematically analysed.Older people with mild frailty reported engaging in a variety of lifestyle behaviours to promote health and well-being. Key barriers or facilitators to engaging in these included transport, knowledge of local services, social support and acceptance of personal limitations. Older people, carers and professionals agreed that any new service should address social networks and mobility and tailor other content to each individual. Services should aim to increase motivation through focussing on independence and facilitate older people to continue carrying out behaviours that improve their wellbeing, as well as provide information, motivation, psychological support and practical support. Stakeholders agreed services should be delivered over a sustained period by trained non-specialist workers. New services including these components are likely to be acceptable to older people with mild frailty. K E Y W O R D Shealth behaviours, health promotion, older people, older people's services, qualitative researchThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…Through the eyes of participants elderly people seemed passive [not undertaking an action], or stubborn [not wanting to undertake an action]. Although physical or cognitive decline may cause less activity, research does not confirm passivity as a trait from the ageing process (Lommi, Matarese, Alvaro, Piredda, & De Marinis, ). People make decisions on basis of their attitudes towards their life and future, having an optimistic character helps to make changes (Lommi et al, ; Sörensen, Hirsch, & Lyness, ).…”

Section: Discussionmentioning

confidence: 99%

Actions to influence the care network of home‐dwelling elderly people: A qualitative study

Kemper-Koebrugge

Adriaansen

Laurant

et al. 2019

Health Soc Care Community

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Positive impact of care networks of home‐dwelling elderly people may be based on several network mechanisms: navigation to resources, negotiation between participants and contagion of behaviours. Little is known about actions of participants—elderly people, informal caregivers or formal care providers—to activate such mechanisms and generate support. Aim of this study was to identify actions in relation to these network mechanisms. A cross‐sectional qualitative study of 48 interviews with home‐dwelling elderly people, informal caregivers and formal care providers in the eastern parts of the Netherlands was conducted between March and September 2016. A framework analysis on network mechanisms categorised actions. Actions were reviewed by network party and compared between networks to explore relations between actions and networks. Results showed that participants navigated through existing relations to seek support. Actions on negotiation were aimed at ameliorating existing relations. Few examples and no actions on contagion of behaviours were found. Actions seemed driven by incidents and existing relations. Elderly people rarely initiated actions, informal caregivers felt hampered by their position in the network. Consistent patterns of relations between actions and network characteristics did not emerge. We concluded that the full potential of network‐based support of elderly people is probably underused. Particularly promising seem: navigating the neighbourhood for new informal care, using opposite opinions as a catalyst for change and bringing quality of life and dilemma's into dialogue in the network.

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The experiences of self-care in community-dwelling older people: A meta-synthesis

Cited by 28 publications

References 29 publications

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

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

Actions to influence the care network of home‐dwelling elderly people: A qualitative study

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