Sally Keeling

Home-based activity program for older people with depressive symptoms: DeLLITE--a randomized controlled trial.

PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODS We undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months’ follow-up. RESULTS The mean age of the participants was 81 years, and 59% were women. All participants scored in the at–risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSION The DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control.

Environmental influences on healthy and active ageing: a systematic review

ABSTRACT This paper explores the evidence for environmental influences on older adult health and activity participation, identifies current knowledge gaps and limitations within this literature, and offers recommendations for future research via a systematic appraisal of 83 quantitative and qualitative studies. A Cochrane-type review procedure was followed, which incorporated structured database searches, inclusion and exclusion criteria, quality appraisal of included studies, and peer review. The review findings identify support for both personal and environmental influences on health and activity participation in later life. Reported personal influences include ethnicity and cultural norms, energy and motivation, sex, age, education, genetic heritage, self-efficacy, and personal financial circumstances. Reported environmental influences on activity participation include climate, level of pollution, street lighting, traffic conditions, accessibility and appropriateness of services and facilities, socio-economic conditions, aesthetics, pedestrian infrastructure, community life, exposure to antisocial behaviour, social network participation, environmental degradation, level of urbanism, exposure to natural settings, familiarity with local environment and others. Recommendations for future research include the need for innovative research methods; involvement of older adults as research collaborators; investigation of wider aspects of the active ageing concept; in-depth assessment of the environmental characteristics of areas; investigation of the pathways leading from environment to health and activity participation; and more theoretically informed research or increased contribution of research to theory development.

Life and Living in Advanced Age: A Cohort Study in New Zealand -Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: Study protocol

BackgroundThe number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand.Methods/designA total population cohort study of those of advanced age. Two cohorts of equal size, Māori aged 80–90 and non-Māori aged 85, oversampling to enable sufficient power, were enrolled. A defined geographic region, living in the Bay of Plenty and Lakes District Health Board areas of New Zealand, defined the sampling frame. Rūnanga (Māori tribal organisations) and Primary Health Organisations were subcontracted to recruit on behalf of the University. Measures - a comprehensive interview schedule was piloted and administered by a trained interviewer using standardised techniques. Socio-demographic and personal history included tribal affiliation for Māori and participation in cultural practices; physical and psychological health status used standardised validated research tools; health behaviours included smoking, alcohol use and nutrition risk; and environmental data included local amenities, type of housing and neighbourhood. Social network structures and social support exchanges are recorded. Measures of physical function; gait speed, leg strength and balance, were completed. Everyday interests and activities, views on ageing and financial interests complete the interview. A physical assessment by a trained nurse included electrocardiograph, blood pressure, hearing and vision, anthropometric measures, respiratory function testing and blood samples.DiscussionA longitudinal study of people of advanced age is underway in New Zealand. The health status of a population based sample of older people will be established and predictors of successful ageing determined.

The jungle of quality of life: Mapping measures and meanings for elders

The literature on quality of life (QOL) can be described as a jungle: vast, dense and difficult to penetrate, especially for those entering the field without a specialist QOL background. While QOL as a term is entwined in an extensive body of work from many disciplines and covering diverse perspectives, it has been most extensively documented and operationalised within the domains of health‐related socioeconomic drivers and is largely quantitative in nature. Subjective and qualitative measurement is less fully developed and documented. This review paper provides a map through the QOL literature by constructing a tabular framework to position the measures and meanings of QOL prior to undertaking a phenomenological study with older people. It concludes by arguing for attention to the further development of qualitative experiential measures specific to life‐stage QOL for older people, having found these perspectives rarely visible.

DeLLITE Depression in late life: an intervention trial of exercise. Design and recruitment of a randomised controlled trial

BackgroundPhysical activity shows potential in combating the poor outcomes associated with depression in older people. Meta-analyses show gaps in the research with poor trial design compromising certainty in conclusions and few programmes showing sustained effects.Methods/designThe Depression in Late Life: an Intervention Trial of Exercise (DeLLITE) is a 12 month randomised controlled trial of a physical activity intervention to increase functional status in people aged 75 years and older with depressive symptoms. The intervention involves an individualised activity programme based on goal setting and progression of difficulty of activities delivered by a trained nurse during 8 home visits over 6 months. The control group received time matched home visits to discuss social contacts and networks. Baseline, 6 and 12 months measures were assessed in face to face visits with the primary outcome being functional status (SPPB, NEADL). Secondary outcomes include depressive symptoms (Geriatric Depression Scale), quality of life (SF-36), physical activity (AHS Physical Activity Questionnaire) and falls (self report).DiscussionDue to report in 2008 the DeLLITE study has recruited 70% of those eligible and tests the efficacy of a home based, goal setting physical activity programme in improving function, mood and quality of life in older people with depressive symptomatology. If successful in improving function and mood this trial could prove for the first time that there are long term health benefit of physical activity, independent of social activity, in this high risk group who consume excess health related costs.Trial registrationAustralian and New Zealand Clinical Trials Register ACTRN12605000475640

Issues influencing the decision to have upper limb surgery for people with tetraplegia.

Study design:Grounded theory.Objectives:To explore to better understand the decision-making process of people with tetraplegia regarding reconstructive upper limb (UL) surgery.Setting:New Zealand.Methods:In-depth interviews with 22 people with tetraplegia, 10 of whom had UL surgery and 12 had not. Verbatim transcripts were analysed using constructivist grounded theory.Results:The primary reason for having reconstructive UL surgery was to improve independence and return to previous pastimes. Reasons not to have surgery were hope for further recovery or cure, and inadequate physical environment or social supports while rehabilitating. In addition, women identified the temporary loss of independence and need for increased care while rehabilitating as issues. Importantly, these issues were not static, often changing in importance or relevance over time.Conclusions:The moment of making the decision for reconstructive UL surgery is elusive; therefore, multiple offers of surgery at different timeframes in an individuals life are required. In addition, flexibility in timing for surgery would allow for surgery to better coordinate with an individuals goals and priorities.

Reasons for changing alcohol use among older people in New Zealand

Objective:  To determine self‐reported reasons for drinking alcohol and for changing alcohol use in older people.

Comprehensive clinical assessment of home-based older persons within New Zealand: an epidemiological profile of a national cross-section.

Objective: Since 2012, all community care recipients in New Zealand have undergone a standardised needs assessment using the Home Care International Residential Assessment Instrument (interRAI‐HC). This study describes the national interRAI‐HC population, assesses its data quality and evaluates its ability to be matched.

Relative distance: ageing in rural New Zealand

This paper explores aspects of kinship and geographical distance in terms of the social context of older people in the South Island of New Zealand, and with particular reference to the long-term epidemiological study of ageing in the community of Mosgiel. Comparisons between the numbers of relatives reported in the social networks of the older participants at baseline and in the six-year follow-up study indicate both losses and gains over time. A local qualitative study carried out within the Mosgiel study interprets meanings of closeness and distance from the ways that older people talk about family and friends. In discussing definitions of family, aspects of genealogical and generational connection are described, along with processes which allow for ‘proxies’ and ‘substitution’ in the light of geographical proximity. These role definitions within families, and the wider social networks within which they operate, provide continuity and reliable social support together with flexibility and adaptability to change. The Mosgiel study illustrates some aspects of the combined effects of low population density in the region, rural-to-urban migration, and recent health and social service restructuring on older people and on their families.

Decision-Making About Upper Limb Tendon Transfer Surgery by People With Tetraplegia for More Than 10 Years

OBJECTIVES To quantify time from spinal cord injury to upper limb reconstructive surgery for individuals with tetraplegia; to explore influences on decision-making about surgery for persons with long-standing (>10y) tetraplegia; and to determine the applicability of our previously developed conceptual framework that described the decision-making processes for people with tetraplegia of <5 years. DESIGN Quantitative-qualitative mixed-methods study. SETTING Community based in New Zealand. PARTICIPANTS People (N=9) living with tetraplegia for >10 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES An audit of time frames between injury, assessment, and surgery for people with tetraplegia was undertaken. Interviews of people with tetraplegia were analyzed using constructivist grounded theory. RESULTS Sixty-two percent of people with tetraplegia assessed for surgery had upper limb reconstructive surgery. Most were assessed within the first 3 years of spinal cord injury. Over half had surgery within 4 years after injury; however, 20% waited >10 years. Changes in prioritized activities, and the identification of tasks possible with surgery, were influential in the decision-making process. Participants were aware of surgery, but required a reoffer from health professionals before proceeding. The influence of peers was prominent in reinforcing the improvement in prioritized activities possible after surgery. CONCLUSIONS Findings confirmed that the previously developed conceptual framework for decision-making about upper limb reconstructive surgery was applicable for people with tetraplegia of >10 years. Similarities were seen in the influence of goals and priorities (although the nature of these might change) and information from peers (although this influence was greater for those injured longer). Repeat offers for surgery were required to allow for changes in circumstances over time.