Kareen Nour

Behavior change following a self-management intervention for housebound older adults with arthritis: an experimental study

BackgroundThis study examined the impact of a home-based self-management intervention for housebound older adults with arthritis on the adoption of health behaviors. The moderating role of socio-demographic, psychological, and physical characteristics in the process of behavior change was also investigated.MethodsParticipants were 113 older adult women (n = 102) and men (n = 11) with osteoarthritis (OA) or rheumatoid arthritis (RA) who were randomly assigned to experimental (n = 68) or wait list control (n = 45) groups. Participants were interviewed using standardized questionnaires at baseline, pre-intervention, and post-intervention.ResultsAdjusted multilevel modeling analyses indicated that from pre to post intervention, experimental participants significantly increased their weekly frequency of exercise and relaxation activities. Socioeconomic status and depression played a moderating role in this change for exercise with larger effects occurring among more privileged, non-depressed participants.ConclusionWe conclude that a self-management intervention can successfully improve involvement in exercise and relaxation among housebound older adults with arthritis.

Short-Term Effects of a Self-Management Intervention on Health Status of Housebound Older Adults With Arthritis

This study examines the impact of a self-management intervention for housebound adults with arthritis and presence of moderating variables. A total of 113 adults with a mean age of 77.7 years and diagnosed with osteoarthritis (62%) or rheumatoid arthritis (38%) were randomized to intervention (n = 65) and control groups (n = 48). Information on health, self-efficacy, outcome expectations, and health behaviors was collected (a) at baseline, (b) 2 months later, and (c) following the intervention. Multilevel analysis reveals that experimental group participants reported significantly fewer functional limitations and less helplessness than control participants postintervention. A trend for improved coping effectiveness was observed (p = .06). Greater improvements in outcome expectations and physical behaviors were associated with greater decreases in helplessness. Larger improvements in outcome expectations were associated with greater decreases in functional limitations. A structured self-management intervention can have a positive impact on the health status of housebound adults with arthritis.

Long-term maintenance of increased exercise involvement following a self-management intervention for housebound older adults with arthritis

BackgroundSustained maintenance of health behaviors is a determinant of successful symptom reduction strategies for older adults with arthritis. This study examined whether or not short-term improvements in exercise involvement were maintained 8 months following a home-based arthritis self-management intervention as well as the moderating role of individual characteristics in the maintenance of behavior change.MethodsOf the 113 housebound older adult participants at pre-intervention, 97 completed the post-intervention interview, and 80 completed the 8-month post-intervention interview.ResultsSome post-intervention improvements in exercise involvement were maintained 8 months later. More specifically, weekly exercise frequency, particularly regarding walking frequency, and variety of exercise activities were still significantly greater in the experimental group than in the control group 8 months following the completion of the intervention. No moderating influences were observed for any of the individual characteristics.ConclusionWe conclude that gains in exercise involvement achieved through a self-management intervention can be maintained 8 months following the intervention.

Nutrition Risk in Home-Bound Older Adults: Using Dietician-Trained and Supervised Nutrition Volunteers for Screening and Intervention

Le dépistage du risque nutritionnel et l’intervention hâtive en nutrition auprès de la population âgée confinéeà domicile sont des déterminants clésdelaprévention de divers problèmes de santé et d’incapacités physiques chez cette population. Cette étude pilote avait pour objectifs: (a) de mesurer la fidélité de l’instrument de mesure « Questionnaire de dépistage nutritionnel des aînés » (ENS©) lorsqu’administré par une nutritionniste et par un bénévole formé; et (b) d’explorer la faisabilité pour un bénévole de faire du dépistage et de l’intervention en nutrition auprès d’une population âgée confinée recevant des services de soutien à domicile. Les participants (n = 29) et les bénévoles (n = 15) étaient des personnes âgées vivant dans la communauté. Les bénévoles ont rencontré les participants, ont évalué leur risque nutritionnel à partir de l’échelle de dépistage ENS©, ont offert de l’éducation nutritionnelle, et ont développé et aidé à l’implantation des plans d’intervention nutritionnelle. Afin de calculer la fidélité inter juges du ENS©, les résultats obtenus à partir de cet instrument par les bénévoles et par la nutritionniste ont été comparés. Le pourcentage de concordance était élevé (80 %) pour la plupart des items, mais plus élevé parmi les bénévoles qu’entre les bénévoles et la nutritionniste. Nous croyons que des bénévoles formés au sujet de la nutrition peuvent épauler les nutritionnistes pour le dépistage et l’éducation des risques nutritionnels, mais que l’intervention nutritionnelle devrait être réservée aux professionnels. Nutrition screening and early intervention in home-bound older adults are key to preventing unfavourable health outcomes and functional decline. This pilot study’s objectives were (a) to test the reliability of the Elderly Nutrition Screening Tool (ENS©) when administered by dietician-trained and supervised nutrition volunteers, and (b) to explore the feasibility of volunteers’ doing nutrition screening and intervention for home-bound older adults receiving home care services. Both participating clients (n = 29) and volunteers (n = 15) were community-dwelling older adults. Volunteers met with participating clients, assessed nutritional risk with the ENS©, provided nutritional education, and developed and helped implement intervention plans. To assess ENS© inter-rater reliability, we compared results obtained by nutrition volunteers and a dietician. Agreement was high (80%) for most items but was higher among volunteers than between volunteers and the dietician. We conclude that nutrition volunteers can assist in screening and educating older adults regarding nutritional risks, but intervention is best left to professionals.

Jog Your Mind: methodology and challenges of conducting evaluative research in partnership with community organizations.

BACKGROUND Jog Your Mind is a community-based program aiming at empowering elderly people to maintain their cognitive abilities using a multi-strategic approach including cognitively stimulating activities, mnemonic strategies, and strategies to promote healthy behaviors. It is offered to elderly individuals without known or diagnosed cognitive impairment by volunteers or community practitioners over ten weekly sessions. This paper describes the protocol of a quasi-experimental study designed to evaluate Jog Your Mind. METHODS Community responsible to recruit participants were either assigned to the experimental group (participating in the Jog Your Mind program) or to the control group (one-year waiting list). All participants were interviewed at baseline (T1), after the program (T2), and 12 months after the baseline (T3). Primary outcomes were the use of everyday memory strategies and aids and subjective memory functioning in daily life. Secondary outcomes included attitudes, knowledge, and behaviors related to cognitive vitality and cognitive abilities (memory and executive functions). Program delivery, organizational and environmental variables were recorded to document the implementation process. RESULTS Twenty-three community organizations recruited 294 community-dwelling elderly individuals in total at T1. Between T1 and T3, an attrition rate of 15.2% was obtained. CONCLUSIONS Jog Your Mind is one of the only programs targeting cognition among older adults being offered in community settings by community practitioners. The protocol described was designed with a focus on maximizing broad generalizations of the results while achieving scientific rigor. It can serve as an example to guide future research aiming to evaluate health interventions under natural conditions.

Perspective écologique sur les déterminants de la vitalité cognitive des aînés

Le vieillissement cognitif demeure une réalité très hétérogène chez la population aînée. Des études ont récemment identifié certains facteurs pouvant contribuer à maintenir la santé cognitive des aînés. À ce jour, ces recherches ont principalement porté sur des déterminants individuels, notamment : les conditions de santé et les habitudes de vie. Une recension des écrits a été réalisée afin d’explorer les facteurs socio-environnementaux qui peuvent influencer la vitalité cognitive des aînés. Cette recension montre que les études qui ont examiné ce lien potentiel sont très rares. Seuls le type et le niveau socio-économique du quartier de résidence, ainsi que la taille du réseau social ont été identifiés comme facteurs d’influence. Par contre, des études ont montré que l’environnement pouvait moduler certaines habitudes de vie qui, à leur tour, peuvent influencer la cognition. Le présent article s’inspire d’une approche écologique afin d’illustrer des cibles individuelles et socio-environnementales de la promotion de la santé cognitive des aînés.Cognitive aging is a heterogeneous reality among the senior population. Studies have recently identified certain factors that may contribute to maintaining the cognitive health of seniors. To date, these research studies have primarily focused on individual determinants, namely: health conditions and lifestyle habits. A review of the literature was conducted in order to explore the socio-environmental factors that may influence the cognitive vitality of seniors. This review demonstrates that studies that have examined this potential link are very rare. Only the type and socioeconomic level of the neighbourhood of the residence, as well as the size of the social network, were identified as influential factors. However, studies have shown that the environment could modulate certain lifestyle habits which, in turn, can influence cognition. This article uses an ecological approach to illustrate individual and socio-environmental targets for the promotion of the cognitive health of seniors.

Intersectoral Co-construction of a Community-Based Workshop for Respectful Sharing of Public Transportation

Challenges of seniors’ use of public transportation and efforts to minimize them call upon intersectoral action. A seniors’ community group partnered with a local health agency to develop an intergenerational workshop aiming to promote respectful sharing of public transportation among teenagers. This article describes the steps of an intersectoral and interdisciplinary co-construction process in which high schools, a local health agency, the transportation sector, academia and seniors’ community organizations collaborated. This led to the development of a workshop that was both feasible and appreciated by the main stakeholders. Lessons learned from this collaborative process for developing intersectoral community-based initiatives are discussed.

Les pratiques de soins palliatifs à domicile: lieu d'exclusion sociale des personnes âgées en fin de vie?

The understanding of palliative care practices at home (PCH) is limited by the lack of available scientific knowledge. This is explained by the fact that its practices are relatively recent and they question our relationship with death and dying individuals. This study aims to contribute to the advancement of knowledge about PCH with the elderly. More specifically, with a perspective of social exclusion, it aims to understand how practices either do or do not produce social exclusion with seniors receiving palliative care. Nineteen participants from two local community services centers were interviewed and six multidisciplinary meetings were attended for observation. This study suggests that positive representations concerning the elderly in palliative care and recognition of their autonomy can avoid social exclusion, including its symbolic and identificatory dimensions. However, standardization of practices seems to contribute to institutional exclusion and foster nonrecognition.

Cognitive Health Promotion Program for Community-Dwelling Seniors: Who Are We Reaching?

This exploratory study examines the reach of Jog Your Mind, a multifactorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. The aim was to determine whether the program successfully reached its target population and to compare the characteristics of participants (sociodemographic, health, lifestyle, attitudes, and cognitive profile) with the general population of seniors. Twenty-three community organizations recruited 294 community-dwelling seniors willing to participate in the program. Descriptive analyses revealed that the participants were mostly Canadian-born educated women living alone. Participants’ health profile and lifestyle behaviors were fairly similar to those of seniors in Québec and Canada. A large proportion of the participants were concerned about their memory. These results suggest that the program did not attract many hard-to-reach members of the population and reached seniors who may have had some cognitive challenges. Cues to action for improving the reach of cognitive health promotion programs are discussed.