Samuel R. Nyman

Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the cochrane systematic review

BACKGROUND Randomised controlled trials (RCTs) of fall prevention conducted in community settings have recently been systematically reviewed. OBJECTIVE To augment this review by analysing older peoples participation in the trials and engagement with the interventions. DESIGN Review of the 99 single and multifactorial RCTs included in the Cochrane systematic review of falls prevention interventions. SETTING Community. PARTICIPANTS Adults aged 60+/mean age minus one standard deviation of 60+. METHODS Calculated aggregate data on recruitment (proportion who accepted the invitation to participate), attrition at 12 month follow-up (loss of participants), adherence (to intervention protocol) and whether adherence moderated the effect of interventions on trial outcomes. RESULTS The median recruitment rate was 70.7% (64.2-81.7%, n = 78). At 12 months the median attrition rate including mortality was 10.9% (9.1-16.0%, n = 44). Adherence rates (n = 69) were ≥80% for vitamin D/calcium supplementation; ≥70% for walking and class-based exercise; 52% for individually targeted exercise; approximately 60-70% for fluid/nutrition therapy and interventions to increase knowledge; 58-59% for home modifications; but there was no improvement for medication review/withdrawal of certain drugs. Adherence to multifactorial interventions was generally ≥75% but ranged 28-95% for individual components. The 13 studies that tested for whether adherence moderated treatment effectiveness produced mixed results. CONCLUSIONS Using median rates for recruitment (70%), attrition (10%) and adherence (80%), we estimate that, at 12 months, on average half of community-dwelling older people are likely to be adhering to falls prevention interventions in clinical trials.

Psychosocial impact of visual impairment in working-age adults

Aim To review the evidence for the presence of lower levels of psychosocial well-being in working-age adults with visual impairment and for interventions to improve such levels of psychosocial well-being. Methods Systematic review of quantitative studies published in English from 2001 to July 2008 that measured depression/mental health, anxiety, quality of life, social functioning or social support. Results Included were 29 studies that measured one or more outcomes (N=52). Working-age adults with visual impairment were significantly more likely to report lower levels of mental health (mean difference=14.51/100), social functioning (MD=11.55/100) and quality of life. Studies regarding the prevalence of depressive symptoms produced inconsistent results but had methodological limitations. Conclusions Future research is required into the prevalence of loneliness, anxiety and depression in adults with visual impairment, and to evaluate the effectiveness of interventions for improving psychosocial well-being such as counselling, peer support and employment programmes.

Older people's recruitment, sustained participation, and adherence to falls prevention interventions in institutional settings: a supplement to the Cochrane systematic review

BACKGROUND randomised controlled trials (RCTs) of falls prevention conducted in institutional settings have recently been systematically reviewed. OBJECTIVE to supplement this review by analysing older peoples participation in the trials and engagement with the interventions. DESIGN review of the 41 RCTs included in the Cochrane systematic review of falls prevention interventions. SETTING hospitals and nursing care facilities. PARTICIPANTS adults aged/mean age of 65+. METHODS calculated aggregate data on recruitment (inclusion into the trial), attrition at 12-month follow-up (loss of participants from the trial), adherence (to intervention protocol), and whether adherence moderated the effect of interventions on trial outcomes. RESULTS the median inclusion rate was 48.5% (38.9-84.5%). At 12 months the median attrition rate was 10.4% (3.9-12.3%, n = 10) or with the inclusion of mortality 16.2% (9.5-17.1%, n = 11). Adherence was high for exercise that was individually targeted (e.g. 89% physical therapy) and group based (72-88%) and for medication interventions (68-88%). For multifactorial interventions, adherence ranged from 11% for attending 60+/88 of exercise classes to 93% for use/repairs of aids. Adherence as a moderator of treatment effectiveness was tested in nursing care facilities (n = 6) and positively identified in three studies for medication and multifactorial interventions. CONCLUSIONS using median rates for recruitment (50%), attrition (15%) and adherence (80%), by 12 months, it is estimated that on average only a third of nursing care facility residents are likely to be adhering to falls prevention interventions.

Emotional well-being and adjustment to vision loss in later life: a meta-synthesis of qualitative studies

Purpose: To review perceived emotional well-being in older people with visual impairment and perceived factors that inhibit/facilitate psychosocial adjustment to vision loss. Method: The databases of MEDLINE, EMBASE, PsycINFO and CINAHL were searched for studies published from January 1980 to December 2010, which recruited older people with irreversible vision loss, and used qualitative methods for both data collection and analysis. Results sections of the papers were synthesised using a thematic-style analysis to identify the emergent and dominant themes. Results: Seventeen qualitative papers were included in the review, and five main themes emerged from the synthesis: 1) the trauma of an ophthalmic diagnosis, 2) impact of vision loss on daily life, 3) negative impact of visual impairment on psychosocial well-being, 4) factors that inhibit social well-being, and 5) factors that facilitate psychological well-being. We found the response shift model useful for explaining our synthesis. Conclusions: Acquired visual impairment can have a significant impact on older people’s well-being and make psychosocial adjustment to the condition a major challenge. Acceptance of the condition and a positive attitude facilitate successful psychosocial adjustment to vision loss as well as social support from family, friends and peers who have successfully adjusted to the condition. Implications for Rehabilitation Visual impairment can have a profound negative impact on individuals’ psychosocial well-being. The emotional needs of those with visual impairment should not to be neglected, particularly those recently diagnosed. Referrals to services may be appropriate for individuals with vision loss (e.g. counselling and peer support groups). It may also be appropriate to discuss with individuals the factors that inhibit/facilitate psychosocial adjustment to vision loss.

Characteristics of outdoor falls among older people: A qualitative study

BackgroundFalls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented.MethodsWe conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses.ResultsForty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week.ConclusionsThis exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.

Usability and acceptability of a website that provides tailored advice on falls prevention activities for older people

This article presents the usability and acceptability of a website that provides older people with tailored advice to help motivate them to undertake physical activities that prevent falls. Views on the website from interviews with 16 older people and 26 sheltered housing wardens were analysed thematically. The website was well received with only one usability difficulty with the action plan calendar. The older people selected balance training activities out of interest or enjoyment, and appeared to carefully add them into their current routine. The wardens were motivated to promote the website to their residents, particularly those who owned a computer, had balance problems, or were physically active. However, the participants noted that currently a minority of older people use the Internet. Also, some older people underestimated how much activity was enough to improve balance, and others perceived themselves as too old for the activities.

Use of personal call alarms among community-dwelling older people

ABSTRACT Having a fall and then lying on the floor for an hour or more is known as a ‘long lie’, which is associated with serious injury and an elevated risk of admission to hospital, long-term care and death. Personal call alarms are designed to prevent long lies, although little is known about their use. Using cross-sectional data from the English Longitudinal Study on Ageing, this study investigated the proportion of self-reported users of personal call alarms among 3,091 community-dwelling adults aged 65+ who reported difficulties of mobility or activities of daily living. The characteristics of users were then explored through logistic regressions comparing those living alone with those living with others. One hundred and eighty people self-reported using a personal call alarm (6%). Multivariate regression found the following to significantly predict personal call alarm use among both those living alone and with others: greater difficulty with activities/instrumental activities of daily living, older age, and for those living with others only: lower score on the quality of life subscale for control. Personal call alarm use may be markedly lower than the 30 per cent annual incidence of falls among community-dwelling older people. Better understanding is needed of the reasons for low usage, even amongst those at highest falls risk for whom such alarms are most likely to be beneficial.

Emotional well-being in people with sight loss Lessons from the grey literature

Literature that is not peer-reviewed and distributed through a publisher is known as ‘grey’. As it is used to inform policy and practice we reviewed the grey literature concerning emotional well-being in people with sight loss. We consulted and searched the websites of UK voluntary organizations, and scanned reference lists of previous reviews for reports available from 2001 to 2008. We summarized 24 studies in two sections: observations that assessed psychosocial well-being or demand for support services (n = 15); and evaluations of interventions that aimed to improve emotional well-being (n = 9). Observations showed that people with sight loss can report low emotional well-being, but their statistical and clinical significance requires testing. Interventions showed promise for counselling but also require further evaluation. We encourage service providers and researchers to collaborate and produce high quality research to more persuasively inform policy and practice.

Increasing walking among older people: A test of behaviour change techniques using factorial randomised N-of-1 trials

Objective: Evaluations of techniques to promote physical activity usually adopt a randomised controlled trial (RCT). Such designs inform how a technique performs on average but cannot be used for treatment of individuals. Our objective was to conduct the first N-of-1 RCTs of behaviour change techniques with older people and test the effectiveness of the techniques for increasing walking within individuals. Design: Eight adults aged 60–87 were randomised to a 2 (goal-setting vs. active control) × 2 (self-monitoring vs. active control) factorial RCT over 62 days. The time series data were analysed for each single case using linear regressions. Main outcome measures: Walking was objectively measured using pedometers. Results: Compared to control days, goal-setting increased walking in 4 out of 8 individuals and self-monitoring increased walking in 7 out of 8 individuals. While the probability for self-monitoring to be effective in 7 out of 8 participants was beyond chance (p = .03), no intervention effect was significant for individual participants. Two participants had a significant but small linear decrease in walking over time. Conclusion: We demonstrate the utility of N-of-1 trials for advancing scientific enquiry of behaviour change and in practice for increasing older people’s physical activity.

Meaningful Activities for Improving the Wellbeing of People with Dementia: Beyond Mere Pleasure to Meeting Fundamental Psychological Needs

Aims: Dementia is being increasingly recognised as a major public health issue for our ageing populations. A critical aspect of supporting people with dementia is facilitating their participation in meaningful activities. However, research to date has not drawn on theories of ageing from developmental psychology that would help undergird the importance of such meaningful activity. For the first time, we connect existing activity provision for people with dementia with developmental psychology theories of ageing. Method: We reviewed the literature in two stages: first, we narratively searched the literature to demonstrate the relevance of psychological theories of ageing for provision of meaningful activities for people with dementia, and in particular focused on stage-based theories of adult development (Carl Jung and Erik Erikson), gerotranscendence (Tornstam), selective optimisation with compensation (Baltes and Baltes), and optimisation in primary and secondary control (Heckhausen and Schulz). Second, we systematically searched PubMed and PsycINFO for studies with people with dementia that made use of the aforementioned theories. Results: The narrative review highlights that activity provision for people with dementia goes beyond mere pleasure to meeting fundamental psychological needs. More specifically, that life review therapy and life story work address the need for life review; spiritual/religious activities address the need for death preparation; intergenerational activities address the need for intergenerational relationships; re-acquaintance with previously conducted leisure activities addresses the need for a sense of control and to achieve life goals; and pursuit of new leisure activities addresses the need to be creative. The systematic searches identified two studies that demonstrated the utility of applying Erikson’s theory of psychosocial development to dementia care. Conclusion: We argue for the importance of activity provision for people with dementia to help promote wellbeing among an increasing proportion of older people.