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A comparison of Gordon's functional health patterns model and standard nursing care in symptomatic heart failure patients: A randomized controlled trial.
Türen, S, Enç, N
Applied nursing research : ANR. 2020;:151247
Abstract
BACKGROUND Heart failure (HF) is associated with poor quality of life and increased morbidity and mortality. AIM: This study aimed to investigate effect of application of Gordon's functional health pattern (FHP) model in nursing care of symptomatic HF patients on quality of life, morbidity and mortality in the post-discharge 30-day. METHODS This is a prospective randomized controlled study conducted in a single center. Experimental group received nursing care planned in accordance with Gordon's FHP model. 60 control and 60 experimental HF patients were included in the study. In the control group nursing care was given according to the standard protocol of the hospital whereas in the experimental group nursing care was given in accordance with Gordon's FHP model. Patients in both groups were followed up after discharge at 30th day. RESULTS Mean Minnesota Living with Heart Failure Questionnaire score improved significantly in the experimental group compared to the control group at 30th day (40.2 ± 23.5 vs 62.3 ± 22.9 respectively, p = 0.001). Seven patients (11.7%) in the experimental group and 17 patients (28.3%) in the control group were readmitted in the post discharge 30-day (p = 0.02). Kaplan-Meier survival curve analysis revealed significant difference in 30-day event free survival rates between groups (log-rank p = 0.31). CONCLUSION Application of Gordon's FHP model in the nursing care of HF patients was associated with significantly improved quality of life, and reduced hospital readmission rates at 30th day. This was the only independent predictor of 30-day event free survival.
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The Effectiveness of a PRoactive Multicomponent Intervention Program on Disability in Independently Living Older People: A Randomized Controlled Trial.
van Lieshout, MRJ, Bleijenberg, N, Schuurmans, MJ, de Wit, NJ
The journal of nutrition, health & aging. 2018;(9):1051-1059
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Abstract
BACKGROUND There is an increase in functional limitations and a decline in physical and mental well-being with age. Very few effective lifestyle interventions are available to prevent adverse outcomes such as disability in (pre-) frail older people. The effectiveness of an interdisciplinary multicomponent intervention program to prevent disability in older people in the community was tested. METHOD A randomized controlled trial (RCT) with a one-year follow-up was conducted in the Netherlands. Community-dwelling pre-frail older people aged 65 years and over were invited to participate. Frailty was measured with the Groningen Frailty Indicator (GFI) and categorized into non-frail (GFI=0), pre-frail (GFI = 1-3) and frail (GFI ≥ 4). The intervention program consisted of four components: a medication review, physical fitness, social skills, and nutrition. OUTCOMES The primary outcome was activity of daily living (ADL) measured with the Katz-6. Secondary outcomes were quality of life (SF-12) and healthcare consumption such as hospital admission, nursing home admission and primary care visits. Additional outcomes measured in the intervention group were physical fitness, Instrumental Activities of Daily Living (IADL), muscle strength, walking speed, functional capacity, mobility, feelings of depression and loneliness and nutritional status. The data were collected at baseline, after each intervention component and at a 12-month follow-up. An intention to treat analysis was used. RESULTS In total, there were 290 participants, and 217 (74.8%) completed the study. The mean age was 74 (SD: 7.2), most were pre-frail (59.9%), the majority were female (55.2%), and the individuals were not living alone (61.4%). After the 12-month follow-up, the median Katz-6 score did not change significantly between the two groups; adjusted Odds Ratio (OR) = 0.96 (95% Confidence Interval (CI): 0.39-2.35, p-value 0.92). No statistically significant differences were observed between the groups for quality of life and healthcare consumption. Among the participants in the intervention group, IADL (Friedman's test p <=0.04, X2 =6.50), walking speed (Friedman's test p <0.001, X2 =19.09) and functional capacity (Friedman's test p <0.001, X2 =33.29) improved significantly after the one-year follow-up. Right-hand grip strength improved immediately after completion of the intervention (Wilcoxon signed-rank test p=0.00, z= -3.39) but not after the 12-month follow-up. CONCLUSION The intervention program did not significantly improve daily functioning, quality of life and healthcare consumption among (pre) frail community-dwelling older persons at the one-year follow-up. Participants in the intervention group experienced improvements in walking speed, functional capacity and instrumental activities of daily living. More research is needed to better understand why may benefit and how to identify the target population.
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Fitness training for the old and frail. Effectiveness and impact on daily life coping and self-care abilities.
Schreier, MM, Bauer, U, Osterbrink, J, Niebauer, J, Iglseder, B, Reiss, J
Zeitschrift fur Gerontologie und Geriatrie. 2016;(2):107-14
Abstract
BACKGROUND Limitations of functionality and mobility due to age-related decrease in muscle strength, balance and physical endurance are closely related to weakness, risk of falls, malnutrition as well as an increase in morbidity and mortality. STUDY PARTICIPANTS AND METHODS In a pilot study we developed and evaluated an 8-week equipment-based progressive resistance training program for geriatric day hospital patients (> 65 years) to improve strength, endurance and coordination. Of the 38 patients who entered the study, 20 were randomly assigned to the intervention group (ALFIT training) and 18 to the control group who only participated in the routine program of the day hospital. Motivation, experiences during training and the subjective impact on coping with daily life were examined with qualitative interviews. RESULTS Muscular strength, endurance, coordination and balance improved during the implementation of the ALFIT training program. The most pronounced effects were seen for the leg pressing with an average increase of 27.8 ± 16 kg (mean ± SD) in terms of 1 repetition maximum and an increase of 12.6 ± 23.7 (mean ± SD) in terms of muscular endurance (number of repetitions). Positive effects were also evident for mobility and nutritional status. The results of the interviews suggest that the ALFIT training leads to noticeably better physical function and confidence and can have a positive impact on coping in daily life and self-care abilities. CONCLUSION The results show that ALFIT training was appropriate for the needs of geriatric patients and demonstrated beneficial effects on muscular strength, functionality and mobility. The results of the interviews suggest that even frail old people can be motivated to engage in sports.
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The effects of video observation of chewing during lunch on masticatory ability, food intake, cognition, activities of daily living, depression, and quality of life in older adults with dementia: a study protocol of an adjusted randomized controlled trial.
Douma, JG, Volkers, KM, Vuijk, PJ, Scherder, EJ
BMC geriatrics. 2016;:37
Abstract
BACKGROUND Masticatory functioning alters with age. However, mastication has been found to be related to, for example, cognitive functioning, food intake, and some aspects of activities of daily living. Since cognitive functioning and activities of daily living show a decline in older adults with dementia, improving masticatory functioning may be of relevance to them. A possible way to improve mastication may be showing videos of people who are chewing. Observing chewing movements may activate the mirror neuron system, which becomes also activated during the execution of that same movement. The primary hypothesis is that the observation of chewing has a beneficial effect on masticatory functioning, or, more specifically, masticatory ability of older adults with dementia. Secondary, the intervention is hypothesized to have beneficial effects on food intake, cognition, activities of daily living, depression, and quality of life. METHODS/DESIGN An adjusted parallel randomized controlled trial is being performed in dining rooms of residential care settings. Older adults with dementia, for whom also additional eligibility criteria apply, are randomly assigned to the experimental (videos of chewing people) or control condition (videos of nature and buildings), by drawing folded pieces of paper. Participants who are able to watch each other's videos are assigned to the same study condition. The intervention takes place during lunchtime, from Monday to Friday, for 3 months. During four moments of measurement, masticatory ability, food intake, cognitive functioning, activities of daily living, depression, and quality of life are assessed. Tests administrators blind to the group allocation administer the tests to participants. DISCUSSION The goal of this study is to examine the effects of video observation of chewing on masticatory ability and several secondary outcome measures. In this study, the observation of chewing is added to the execution of the same action (i.e., during eating). Beneficial effects on masticatory ability, and consequently on the other outcome measures are hypothesized. The intervention may be easily integrated into daily care, and might add to the lives of the increasing number of older adults with dementia by beneficially influencing multiple daily life functions. TRIAL REGISTRATION NTR5124. Registration date: 30 March 2015.
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Vitamin D supplementation to prevent depression and poor physical function in older adults: Study protocol of the D-Vitaal study, a randomized placebo-controlled clinical trial.
de Koning, EJ, van Schoor, NM, Penninx, BW, Elders, PJ, Heijboer, AC, Smit, JH, Bet, PM, van Tulder, MW, den Heijer, M, van Marwijk, HW, et al
BMC geriatrics. 2015;:151
Abstract
BACKGROUND Depressive symptoms and decreased physical functioning are interrelated conditions and common in older persons, causing significant individual and societal burden. Evidence suggests that vitamin D supplementation may be beneficial for both mental and physical functioning. However, previous randomized controlled trials have yielded inconsistent results and often had suboptimal designs. This study examines the effect of vitamin D supplementation on both depressive symptoms and physical functioning in a high-risk population of older persons with low vitamin D status. METHODS/DESIGN The D-Vitaal study is a randomized, double-blind, placebo-controlled trial investigating the effects of a daily dose of 1200 IU vitamin D3 versus placebo for one year on depressive symptoms and physical functioning (primary outcomes) in older adults. Participants (N = 155, age 60-80 years) were recruited from the general population. Eligibility criteria included the presence of depressive symptoms, ≥1 functional limitation and serum 25-hydroxyvitamin D levels between 15 and 50/70 nmol/L (depending on season). Secondary outcomes include incidence of major depressive disorder, anxiety symptoms, health-related quality of life, cognitive function and cost-effectiveness of the intervention. DISCUSSION With this study, we aim to elucidate the effects of vitamin D supplementation on depressive symptoms and physical functioning in older persons who are at high risk of developing more substantial mental and physical problems. If effective, vitamin D supplementation can be a preventive intervention strategy that is easy to implement in the primary care setting. TRIAL REGISTRATION Netherlands Trial Register NTR3845. Registered 6 February 2013.
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Positive and cost-effectiveness effect of spa therapy on the resumption of occupational and non-occupational activities in women in breast cancer remission: a French multicentre randomised controlled trial.
Mourgues, C, Gerbaud, L, Leger, S, Auclair, C, Peyrol, F, Blanquet, M, Kwiatkowski, F, Leger-Enreille, A, Bignon, YJ
European journal of oncology nursing : the official journal of European Oncology Nursing Society. 2014;(5):505-11
Abstract
PURPOSE OF THE RESEARCH The main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed. METHODS AND SAMPLE A multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m(2). The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group. KEY RESULTS The main results showed a higher rate of resumption of occupational activities in the intervention group (p = 0.0025) and a positive effect of the intervention on the women's ability to perform occupational activities 12 months after the beginning of the study (p = 0.0014), and on their ability to perform family activities (p = 0.033). The stay in a thermal centre was cost-effective at 12 months. CONCLUSIONS Spa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission.
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Predictors of retention among African American and Hispanic older adult research participants in the Well Elderly 2 randomized controlled trial.
Carlson, M, Jackson, J, Mandel, D, Blanchard, J, Holguin, J, Lai, MY, Marterella, A, Vigen, C, Gleason, S, Lam, C, et al
Journal of applied gerontology : the official journal of the Southern Gerontological Society. 2014;(3):357-82
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The purpose of this study was to document predictors of long-term retention among minority participants in the Well Elderly 2 Study, a randomized controlled trial of a lifestyle intervention for community-dwelling older adults. The primary sample included 149 African American and 92 Hispanic men and women aged 60 to 95 years, recruited at senior activity centers and senior residences. Chi-square and logistic regression procedures were undertaken to examine study-based, psychosocial and health-related predictors of retention at 18 months following study entry. For both African Americans and Hispanics, intervention adherence was the strongest predictor. Retention was also related to high active coping and average (vs. high or low) levels of activity participation among African Americans and high social network strength among Hispanics. The results suggest that improved knowledge of the predictors of retention among minority elders can spawn new retention strategies that can be applied at individual, subgroup, and sample-wide levels.
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The association between mild cognitive impairment and doing housework.
Jiang, C, Xu, Y
Aging & mental health. 2014;(2):212-6
Abstract
OBJECTIVES The ability to perform instrumental activities of daily living (IADL) is thought to be relatively intact for people with mild cognitive impairment (MCI). Doing housework as part of IADL is an important skill needed for older people to live independently and successfully. A limited number of studies explore the association between MCI and doing housework. The aim of this study was to assess the association between MCI and doing housework among old people. METHOD The study employed a community-based, cross-sectional design. A total of 1773 older people residents, aged 60 and over, were randomly recruited in the Suzhou area, and they underwent the Montreal cognitive assessment (MoCA) for screening MCI in 2009. Participants were required to complete a questionnaire, which was comprised of their demographic information, health status, and life style, to evaluate the associations between MCI and these factors. RESULTS About 13% of the respondents were found to have MCI. People with MCI are found to be less healthy and live unhealthy lifestyles. After adjusting confounding factors, a significant association was observed between MCI and not doing housework (Odds ratio (OR) = 1.64; 95% confidence interval (CI) = 1.17-2.30). CONCLUSIONS MCI is associated with doing less housework. The deterioration in the ability to do housework is a potentially important indicator of evolving cognitive impairment in some old people.
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Effects of cognitive training with and without aerobic exercise on cognitively demanding everyday activities.
McDaniel, MA, Binder, EF, Bugg, JM, Waldum, ER, Dufault, C, Meyer, A, Johanning, J, Zheng, J, Schechtman, KB, Kudelka, C
Psychology and aging. 2014;(3):717-30
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We investigated the potential benefits of a novel cognitive-training protocol and an aerobic exercise intervention, both individually and in concert, on older adults' performances in laboratory simulations of select real-world tasks. The cognitive training focused on a range of cognitive processes, including attentional coordination, prospective memory, and retrospective-memory retrieval, processes that are likely involved in many everyday tasks, and that decline with age. Primary outcome measures were 3 laboratory tasks that simulated everyday activities: Cooking Breakfast, Virtual Week, and Memory for Health Information. Two months of cognitive training improved older adults' performance on prospective-memory tasks embedded in Virtual Week. Cognitive training, either alone or in combination with 6 months of aerobic exercise, did not significantly improve Cooking Breakfast or Memory for Health Information. Although gains in aerobic power were comparable with previous reports, aerobic exercise did not produce improvements for the primary outcome measures. Discussion focuses on the possibility that cognitive-training programs that include explicit strategy instruction and varied practice contexts may confer gains to older adults for performance on cognitively challenging everyday tasks.
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The reciprocal effects of pain intensity and activity limitations: implications for outcomes assessment in clinical trials.
Jensen, MP, Molton, IR
The Clinical journal of pain. 2014;(1):9-16
Abstract
OBJECTIVES To examine the reciprocal effects of pain intensity and limitations in physical functioning over time. METHODS This study presents findings from a reanalysis of a 7-center trial conducted in Ontario, Canada, included 209 adults with chronic knee pain secondary to osteoarthritis. Patients were randomized to receive 28 days of therapy with an active solution (1.5% w/w diclofenac sodium in dimethyl sulfoxide) or 1 of 2 control solutions containing no diclofenac. The key outcome measures used in the current analyses were administered throughout the study period and assessed pain intensity, perceived activity limitations, and a composite score measuring both domains. A structural cross-lagged regression approach was used to determine the reciprocal effects of pain and activity limitations over time. RESULTS In both study groups, participants (N=209) experienced significant reductions in mean pain intensity and activity limitations from baseline to weeks 1, 2, 3, and 4 (P<0.001 for both variables). Similarly, there were significant reductions in the activity limitations outcome at weeks 1 and 4 for the active versus control group (P<0.05 for both). Higher levels of perceived activity limitations predicted more future pain at all time points. Cross-lagged associations in which pain predicted subsequent perceived activity limitations were not significant at any time point. All 3 outcome measures evidenced similar responsiveness to the treatment. CONCLUSION These analyses showed that a decrease in activity limitations results in a decrease in pain intensity. However, changes in pain intensity had no effect on subsequent activity limitations in the study sample. None of the 3 outcome variables emerged as being more responsive to treatment than the others.