Nurse's role in geriatric patients rehabilitation with musculoskeletal system diseases.
Niezbecka-Zając Joanna,Zarębska Aneta,Blicharski Rudolf
Wiadomosci lekarskie (Warsaw, Poland : 1960)
OBJECTIVE:Introduction: There is the increasing number of elderly patients with motion disabilities who require help and infatuations from nursing stuff. According to the Central Statistic Department (GUS), 25,4% people in Poland is over 60. In 2050 this number will increase to 40%(39,9%). This is very important topic because when the number of old people will increase the geriatric care will be more important. Especially because this is partially covered by nursing team. They should be satisfied and content of the job they do, and they should fulfill the aim they had when they started this profession. The aim: Analysis of nurse's work with patients, nursing procedures evaluation, how this procedure is scored by the nurse, what is the nurse's role in the rehabilitation process. PATIENTS AND METHODS:Material and methods: There were nursing process with geriatric patients analyzed in this article. There were nursing procedures investigated with the opinion of the person who performed this procedure. Role of the nurse in rehabilitation process was and the satisfaction from typical work load was analyzed. RESULTS:Results: Analyzed results showed that there is a deficit in the nurse's knowledge and the lack of the complex care in elderly patient with disabilities. There is lack of the preparation and education program to perform holistic patient care. This includes monitoring, examination and elderly needs. CONCLUSION:Conclusions: The nurse is the first link that helps the patient to understand his disease. The nurse develops therapeutic contact that helps the patient to feel safe and positively react for the introduced treatment.
Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review.
Hamine Saee,Gerth-Guyette Emily,Faulx Dunia,Green Beverly B,Ginsburg Amy Sarah
Journal of medical Internet research
BACKGROUND:Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management. OBJECTIVE:We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management ("mAdherence"), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers. METHODS:We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users. RESULTS:In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39%). CONCLUSIONS:There is potential for mHealth tools to better facilitate adherence to chronic disease management, but the evidence supporting its current effectiveness is mixed. Further research should focus on understanding and improving how mHealth tools can overcome specific barriers to adherence.
10.2196/jmir.3951
Mobile phone use among patients and health workers to enhance primary healthcare: A qualitative study in rural South Africa.
Anstey Watkins Jocelyn Olivia Todd,Goudge Jane,Gómez-Olivé Francesc Xavier,Griffiths Frances
Social science & medicine (1982)
Mobile phones have the potential to improve access to healthcare information and services in low-resourced settings. This study investigated the use of mobile phones among patients with chronic diseases, pregnant women, and health workers to enhance primary healthcare in rural South Africa. Qualitative research was undertaken in Mpumalanga in 2014. Semi structured in-depth interviews were conducted with 113 patients and 43 health workers from seven primary healthcare clinics and one district hospital. Data were thematically analysed. We found that some health workers and patients used their own mobile phones for healthcare, bearing the cost themselves. Patients used their mobile phones to remind themselves to take medication or attend their clinic visits, and they appreciated receiving voice call reminders. Some patients and health workers accessed websites and used social media to gather health information, but lacked web search strategies. The use of the websites and social media was intermittent due to lack of financial ability to afford airtime among these patients and health workers. Many did not know what to search for and where to search. Doctors have developed their own informal mobile health solutions in response to their work needs and lack of resources due to their rurality. Physical and social factors influence the usability of mobile phones for healthcare, and this can shape communication patterns such as poor eyesight. The bottom-up use of mobile phones has been evolving to fill the gaps to augment primary care services in South Africa; however, barriers to access remain, such as poor digital infrastructure and low digital literacy.
10.1016/j.socscimed.2018.01.011
Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
INTRODUCTION:More than half of older adults (age ≥ 65 yr) have 2 or more high-burden multimorbidity conditions (i.e., highly prevalent chronic diseases, which are associated with increased health care utilization; these include diabetes [DM], dementia, depression, chronic obstructive pulmonary disease [COPD], cardiovascular disease [CVD], arthritis, and heart failure [HF]), yet most existing interventions for managing chronic disease focus on a single disease or do not respond to the specialized needs of older adults. We conducted a systematic review and meta-analysis to identify effective multimorbidity interventions compared with a control or usual care strategy for older adults. METHODS:We searched bibliometric databases for randomized controlled trials (RCTs) evaluating interventions for managing multiple chronic diseases in any language from 1990 to December 2017. The primary outcome was any outcome specific to managing multiple chronic diseases as reported by studies. Reviewer pairs independently screened citations and full-text articles, extracted data and assessed risk of bias. We assessed statistical and methodological heterogeneity and performed a meta-analysis of RCTs with similar interventions and components. RESULTS:We included 25 studies (including 15 RCTs and 6 cluster RCTs) (12 579 older adults; mean age 67.3 yr). In patients with [depression + COPD] or [CVD + DM], care-coordination strategies significantly improved depressive symptoms (standardized mean difference -0.41; 95% confidence interval [CI] -0.59 to -0.22; = 0%) and reduced glycosylated hemoglobin (HbA) levels (mean difference -0.51; 95% CI -0.90 to -0.11; = 0%), but not mortality (relative risk [RR] 0.79; 95% CI 0.53 to 1.17; = 0%). Among secondary outcomes, care-coordination strategies reduced functional impairment in patients with [arthritis + depression] (between-group difference -0.82; 95% CI -1.17 to -0.47) or [DM + depression] (between-group difference 3.21; 95% CI 1.78 to 4.63); improved cognitive functioning in patients with [DM + depression] (between-group difference 2.44; 95% CI 0.79 to 4.09) or [HF + COPD] ( = 0.006); and increased use of mental health services in those with [DM + (CVD or depression)] (RR 2.57; 95% CI 1.90 to 3.49; = 0%). INTERPRETATION:Subgroup analyses showed that older adults with diabetes and either depression or cardiovascular disease, or with coexistence of chronic obstructive pulmonary disease and heart failure, can benefit from care-coordination strategies with or without education to lower HbA, reduce depressive symptoms, improve health-related functional status, and increase the use of mental health services. PROTOCOL REGISTRATION:PROSPERO-CRD42014014489.
10.1503/cmaj.171391
A self-management support program for older Australians with multiple chronic conditions: a randomised controlled trial.
Reed Richard L,Roeger Leigh,Howard Sara,Oliver-Baxter Jodie M,Battersby Malcolm W,Bond Malcolm,Osborne Richard H
The Medical journal of Australia
OBJECTIVE:To determine whether a clinician-led chronic disease self-management support (CDSMS) program improves the overall self-rated health level of older Australians with multiple chronic health conditions. DESIGN:Randomised controlled trial: participants were allocated to a clinician-led CDSMS group (including client-centred goal setting and the development of individualised care plans) or to a control group in which they received positive attention only. SETTING AND PARTICIPANTS:Patients aged 60 years or more with at least two chronic conditions, recruited between September 2009 and June 2010 from five general practices in Adelaide. MAIN OUTCOME MEASURES:The primary outcome was self-rated health. Secondary outcome measures related to health status (fatigue, pain, health distress, energy, depression, illness intrusiveness), health behaviour (exercise, medication adherence), and health service utilisation. RESULTS:254 participants were randomised to the CDSMS and control groups, of whom 231 (117 control and 114 CDSMS participants) completed the 6-month programs and provided complete outcomes data (91%). An intention-to-treat analysis found that CDSMS participants were more likely than control participants to report improved self-rated health at 6 months (odds ratio, 2.50; 95% confidence interval, 1.13-5.50; P = 0.023). Between-group differences for secondary outcomes were not statistically significant. CONCLUSION:CDSMS may benefit some older people with multiple chronic conditions to a greater extent than positive attention and health education. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12609000726257.
10.5694/mja17.00127
Smart Devices for Older Adults Managing Chronic Disease: A Scoping Review.
JMIR mHealth and uHealth
BACKGROUND:The emergence of smartphones and tablets featuring vastly advancing functionalities (eg, sensors, computing power, interactivity) has transformed the way mHealth interventions support chronic disease management for older adults. Baby boomers have begun to widely adopt smart devices and have expressed their desire to incorporate technologies into their chronic care. Although smart devices are actively used in research, little is known about the extent, characteristics, and range of smart device-based interventions. OBJECTIVE:We conducted a scoping review to (1) understand the nature, extent, and range of smart device-based research activities, (2) identify the limitations of the current research and knowledge gap, and (3) recommend future research directions. METHODS:We used the Arksey and O'Malley framework to conduct a scoping review. We identified relevant studies from MEDLINE, Embase, CINAHL, and Web of Science databases using search terms related to mobile health, chronic disease, and older adults. Selected studies used smart devices, sampled older adults, and were published in 2010 or after. The exclusion criteria were sole reliance on text messaging (short message service, SMS) or interactive voice response, validation of an electronic version of a questionnaire, postoperative monitoring, and evaluation of usability. We reviewed references. We charted quantitative data and analyzed qualitative studies using thematic synthesis. To collate and summarize the data, we used the chronic care model. RESULTS:A total of 51 articles met the eligibility criteria. Research activity increased steeply in 2014 (17/51, 33%) and preexperimental design predominated (16/50, 32%). Diabetes (16/46, 35%) and heart failure management (9/46, 20%) were most frequently studied. We identified diversity and heterogeneity in the collection of biometrics and patient-reported outcome measures within and between chronic diseases. Across studies, we found 8 self-management supporting strategies and 4 distinct communication channels for supporting the decision-making process. In particular, self-monitoring (38/40, 95%), automated feedback (15/40, 38%), and patient education (13/40, 38%) were commonly used as self-management support strategies. Of the 23 studies that implemented decision support strategies, clinical decision making was delegated to patients in 10 studies (43%). The impact on patient outcomes was consistent with studies that used cellular phones. Patients with heart failure and asthma reported improved quality of life. Qualitative analysis yielded 2 themes of facilitating technology adoption for older adults and 3 themes of barriers. CONCLUSIONS:Limitations of current research included a lack of gerontological focus, dominance of preexperimental design, narrow research scope, inadequate support for participants, and insufficient evidence for clinical outcome. Recommendations for future research include generating evidence for smart device-based programs, using patient-generated data for advanced data mining techniques, validating patient decision support systems, and expanding mHealth practice through innovative technologies.
10.2196/mhealth.7141
Patient-Centred Care of Older Adults With Cardiovascular Disease and Multiple Chronic Conditions.
Kim Dae Hyun,Rich Michael W
The Canadian journal of cardiology
Multimorbidity, defined as the presence of 2 or more chronic conditions, is common among older adults with cardiovascular disease. These individuals are at increased risk for poor health outcomes and account for a large proportion of health care utilization. Clinicians are challenged with the heterogeneity of this population, the complexity of the treatment regimen, limited high-quality evidence, and fragmented health care systems. Each treatment recommended by a clinical practice guideline for a single cardiovascular disease might be rational, but the combination of all evidence-based recommendations can be impractical or even harmful to individuals with multimorbidity. These challenges can be overcome with a patient-centred approach that incorporates the individual's preferences, relevant evidence, the overall and condition-specific prognosis, clinical feasibility of treatments, and interactions with other treatments and coexisting chronic conditions. The ultimate goal is to maximize benefits and minimize harms by optimizing adherence to the most essential treatments, while acknowledging trade-offs between treatments for different health conditions. It might be necessary to discontinue therapies that are not essential or potentially harmful to decrease the risk of drug-drug and drug-disease interactions from polypharmacy. A decision to initiate, withhold, or stop a treatment should be on the basis of the time horizon to benefits vs the individual's prognosis. In this review, we illustrate how cardiologists and general practitioners can adopt a patient-centred approach to focus on the aspects of cardiovascular and noncardiovascular health that have the greatest effect on functioning and quality of life in older adults with cardiovascular disease and multimorbidity.
10.1016/j.cjca.2016.04.003
Worksite-based internet multimedia program for family caregivers of persons with dementia.
Beauchamp Natasha,Irvine A Blair,Seeley John,Johnson Brian
The Gerontologist
PURPOSE:Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia. DESIGN AND METHODS:The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest randomized clinical trial with a 30-day follow-up and a waitlist control condition. Validated instruments include the Center for Epidemiologic Studies-Depression scale, the State-Trait Anxiety Inventory, the Caregiver Strain scale from Benjamin Rose, and Positive Aspects of Caregiving used in the nationwide REACH study. RESULTS:Those who viewed Caregiver's Friend: Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression, anxiety, level and frequency of stress, caregiver strain, self-efficacy, and intention to seek help, as well as perceptions of positive aspects of caregiving. IMPLICATIONS:Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost, effective, convenient, individually tailored programs that present educational information, cognitive and behavioral skills, and affective learning opportunities. This makes Web-based multimedia a promising avenue for work-life balance programs, employee-assistance providers, and organizations interested in improving family caregiver health and well-being.
10.1093/geront/45.6.793
Online Health Information-Seeking Among Older Women With Chronic Illness: Analysis of the Women's Health Initiative.
Sedrak Mina S,Soto-Perez-De-Celis Enrique,Nelson Rebecca A,Liu Jennifer,Waring Molly E,Lane Dorothy S,Paskett Electra D,Chlebowski Rowan T
Journal of medical Internet research
BACKGROUND:Understanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population. OBJECTIVE:The objective of our study was to describe online health information-seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not. METHODS:The study population included 72,806 women aged 65 years and older enrolled in the Women's Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% CIs. RESULTS:Of the total, 59% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90% [38,481/42,887] vs 87% [26,017/29,919]), earned a higher income (over $US 50,000: 55% [23,410/42,887] vs 33% [9991/29,919]), achieved a higher educational level (more than high school: 87% [37,493/42,887] vs 75% [22,377/29,919]), and were more likely to live with a partner (52% [22,457/42,887] vs 36% [10,759/29,919]) (all P<.001). Women with Alzheimer disease were least likely to report online health information-seeking compared to those without the disease (OR 0.41, 95% CI 0.38-0.43). In contrast, women with a recent diagnosis of cancer, within the previous 2 years (OR 1.23, 95% CI 1.11-1.36) or 2-5 years ago (OR 1.09, 95% CI 1.00-1.19), were most likely to use the internet for health information. CONCLUSIONS:Nearly 6 in 10 older women participating in the WHI reported using the internet to obtain health information. Patients recently diagnosed with cancer are more likely to be looking for health information online, even after adjustment for age, suggesting that these patients may have a greater need for digital health resources.
10.2196/15906
Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study.
JMIR mHealth and uHealth
BACKGROUND:Most training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes. OBJECTIVE:This feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol. METHODS:The mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol. RESULTS:Of the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence. CONCLUSIONS:A tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting.
10.2196/mhealth.9988
Regular Source of Care for the Elderly: A Cross-National Comparative Study of Hong Kong With 11 Developed Countries.
Wong Samuel Yeung-Shan,Zou Dan,Chung Roger Y,Sit Regina W,Zhang Dexing,Chan Dicken,Yeoh Eng Kiong,Woo Jean W
Journal of the American Medical Directors Association
OBJECTIVE:This study aimed to give an international perspective of health service gaps for caring for elderly individuals and explore the role of primary care for caring for elderly individuals with chronic conditions in Hong Kong. DESIGN:Cross-sectional, telephone survey. SETTING:Hong Kong. PARTICIPANT:A sample of 1000 Chinese participants in Hong Kong aged 60 or older. MEASUREMENTS:Questionnaire extracted from the Commonwealth Fund 2014 International Health Policy Survey of Older Adults. RESULTS:Similar to the 11 countries, more than half (about 65%) of Hong Kong respondents suffered from chronic conditions, whereas approximately one-third of them had at least 2 chronic conditions. US respondents had highest rate of having chronic conditions. Only 65% of Hong Kong respondents reported having a regular source of care and a higher proportion of elderly reported having poor self-rated health when compared with overseas counterparts. However, the proportion of elderly individuals who could access same-day or next-day medical care was higher compared with findings of other countries. Both Hong Kong and US respondents were more likely to report cost-related problems when accessing care. Waiting time for specialists in Hong Kong was much longer and coordination between regular doctors was poorer than in all other countries. Although half of Hong Kong respondents had a management plan for chronic conditions, a smaller proportion of them considered it helpful. CONCLUSIONS:Hong Kong has the lowest rate of regular source of care when compared with 11 developed countries, although people in Hong Kong were more likely to be able to access same-day or next-day medical care. To cope with increasing needs of chronic disease care, there may be a need to further develop the provision of regular source of care for elderly individuals, including the development of quality primary care in Hong Kong.
10.1016/j.jamda.2017.05.009
Four perspectives on self-management support by nurses for people with chronic conditions: a Q-methodological study.
van Hooft Susanne M,Dwarswaard Jolanda,Jedeloo Susan,Bal Roland,van Staa AnneLoes
International journal of nursing studies
BACKGROUND:Self-management support is a major task of nurses in chronic care. Several conceptualizations on what self-management support encompasses are described in the literature. However, nurses' attitudes and perceptions related to self-management support are not known. OBJECTIVE:To reveal distinctive perspectives of nurses toward self-management support in chronic care. DESIGN AND METHODS:A Q-methodological study was conducted in which nurses rank-ordered 37 statements on self-management support. Thereafter they motivated their ranking in semi-structured interviews. PARTICIPANTS AND SETTING:A purposive sample of 49 Dutch nurses with a variety of educational levels, age, and from different healthcare settings was invited by e-mail to participate in the study. Thirty-nine nurses (aged 21-54 years) eventually participated. The nurses worked in the following settings: hospital (n=11, 28%), home-care (n=14, 36%), mental health care (n=7, 17%), elderly care (n=6, 15%) and general practice (n=1, 3%). RESULTS:Four distinct perspectives on the goals for self-management support were identified: the Coach, the Clinician, the Gatekeeper and the Educator perspective. The Coach nurse focuses on the patient's daily life activities, whereas the nurses of the Clinician type aim to achieve adherence to treatment. The goal of self-management support from the Gatekeeper perspective is to reduce health care costs. Finally, the Educator nurse focuses on instructing patients in managing the illness. CONCLUSIONS:The changing role of chronic patients with regard to self-management asks for a new understanding of nurses' supportive tasks. Nurses appear to have dissimilar perceptions of what self-management support entails. These distinct perceptions reflect different patient realities and demand that nurses are capable of reflexivity and sensitivity to patient needs. Different perspectives toward self-management support also call for diverse competencies and consequently, also for adaptation of educational nursing programs.
10.1016/j.ijnurstu.2014.07.004
Development of a Multi-Agent m-Health Application Based on Various Protocols for Chronic Disease Self-Management.
Park Hyun Sang,Cho Hune,Kim Hwa Sun
Journal of medical systems
The purpose of this study was to develop and evaluate a mobile health application (Self-Management mobile Personal Health Record: "SmPHR") to ensure the interoperability of various personal health devices (PHDs) and electronic medical record systems (EMRs) for continuous self-management of chronic disease patients. The SmPHR was developed for Android 4.0.3, and implemented according to the optimized standard protocol for each interface of healthcare services adopted by the Continua Health Alliance (CHA). That is, the Personal Area Network (PAN) interface between the application and PHD implements ISO/IEEE 11073-20,601, 10,404, 10,407, 10,415, 10,417, and Bluetooth Health Device Profile (HDP), and EMRs with a wide area network (WAN) interface implement HL7 V2.6; the Health Record Network (HRN) interface implements Continuity of Care Document (CCD) and Continuity of Care Record (CCR). Also, for SmPHR, we evaluated the transmission error rate between the interface using four PHDs and personal health record systems (PHRs) from previous research, with 611 users and elderly people after receiving institutional review board (IRB) approval. In the evaluation, the PAN interface showed 15 (2.4 %) errors, and the WAN and HRN interface showed 13 (2.1 %) errors in a total of 611 transmission attempts. Also, we received opinions regarding SmPHR from 15 healthcare professionals who took part in the clinical trial. Thus, SmPHR can be provided as an interconnected PHR mobile health service to patients, allowing 'plug and play' of PHDs and EMRs through various standard protocols.
10.1007/s10916-015-0401-5
Community-based exercise for chronic disease management: an Italian design for the United States?
Weinrich Michael,Stuart Mary,Benvenuti Francesco
Neurorehabilitation and neural repair
Although only a small proportion of older adults in the United States engage in recommended amounts of physical exercise, the health benefits of exercise for this population and the potential for lowering health care costs are substantial. However, access to regular exercise programs for the frail elderly and individuals with disabilities remains limited. In the context of health reform and emerging opportunities in developing integrated systems of care, the experience in Tuscany in implementing a community-based program of exercise for the elderly should be of interest.
10.1177/1545968314531073
Demographics, Resource Utilization, and Outcomes of Elderly Patients With Chronic Liver Disease Receiving Hospice Care in the United States.
Fukui Natsu,Golabi Pegah,Otgonsuren Munkhzul,Mishra Alita,Venkatesan Chapy,Younossi Zobair M
The American journal of gastroenterology
OBJECTIVES:Hospice offers non-curative symptomatic management to improve patients' quality of life, satisfaction, and resource utilization. Hospice enrollment among patients with chronic liver disease (CLD) is not well studied. The aim of tis tudy is to examine the characteristics of Medicare enrollees with CLD, who were discharged to hospice. METHODS:Medicare patients discharged to hospice between 2010 and 2014 were identified in Medicare Inpatient and Hospice Files. CLDs and other co-morbidities were identified by International Classification of Diseases-ninth revision codes. Generalized linear model was used to estimate regression coefficients with P-values. Logistic regression was used to calculate odds ratios and 95% confidence intervals. RESULTS:A total of 2,179 CLD patients and 34,986 controls without CLD met the inclusion criteria. Non-alcoholic fatty liver disease, alcoholic liver disease, and hepatitis C virus (HCV) were the most frequent cause of CLD. CLD patients were younger (70 vs. 83 years), more likely to be male (57.7 vs. 39.3%), had longer hospital stay (length of stay, LOS) (19.4 vs. 13.0 days), higher annual charges ($175,000 vs. $109,000), higher 30-day re-hospitalization rates (51.6 vs. 34.2%), and shorter hospice LOS (13.7 vs. 17.7 days) than controls (all P<0.001). Presence of HCV and congestive heart failure were the strongest contributors to increased total annual costs (34% and 31% higher, P<0.001), increased total annual LOS (26% and 43% higher, P<0.001), and increased 30-day readmission risk (2.20 and 2.19 times, respectively). CONCLUSIONS:Patients with CLD have longer and costly hospitalizations before hospice enrollment as compared with patients without CLD. It was highly likely that these patients were enrolled relatively late, which could potentially lead to less benefit from hospice.
10.1038/ajg.2017.290
Perceptions of Health Care Providers Regarding a Mobile Health Intervention to Manage Chronic Obstructive Pulmonary Disease: Qualitative Study.
Alwashmi Meshari F,Fitzpatrick Beverly,Davis Erin,Gamble John-Michael,Farrell Jamie,Hawboldt John
JMIR mHealth and uHealth
BACKGROUND:Using a mobile health (mHealth) intervention, consisting of a smartphone and compatible medical device, has the potential to enhance chronic obstructive pulmonary disease (COPD) treatment outcomes while mitigating health care costs. OBJECTIVE:The aim of this study was to explore the potential facilitators and barriers among health care providers (HCPs) regarding the use of mHealth interventions for COPD management. METHODS:This was a qualitative study. Semistructured individual interviews were conducted with HCPs, including nurses, pharmacists, and physicians who work directly with patients with COPD. A flexible prompts guide was used to facilitate discussions. Interview topics included the following: demographics, mHealth usage, perceptions toward challenges of mHealth adoption, factors facilitating mHealth adoption, and preferences regarding features of the mHealth intervention for COPD management. Interviews were conversational in nature, and items were not asked verbatim or in the order presented. The interviews were transcribed verbatim and compared against the digital recordings to ensure the accuracy of the content. After creating a codebook for analysis, 2 researchers independently coded the remaining interview data using pattern coding. They discussed commonalities and differences in coding until a consensus was reached. RESULTS:A total of 30 nurses, physicians, and pharmacists participated. The main facilitators to mHealth adoption are possible health benefits for patients, ease of use, educating patients and their HCPs, credibility, and reducing cost to the health care system. Alternatively, the barriers to adoption are technical issues, privacy and confidentiality issues, lack of awareness, potential limited uptake from the elderly, potential limited connection between patients and HCPs, and finances. CONCLUSIONS:It is important to understand the perceptions of HCPs regarding the adoption of innovative mHealth interventions for COPD management. This study identifies some potential facilitators and barriers that may inform the successful development and implementation of mHealth interventions for COPD management.
10.2196/13950
Management of inflammatory rheumatic conditions in the elderly.
Lahaye Clément,Tatar Zuzana,Dubost Jean-Jacques,Tournadre Anne,Soubrier Martin
Rheumatology (Oxford, England)
The number of elderly people with chronic inflammatory rheumatic diseases is increasing. This heterogeneous and comorbid population is at particular risk of cardiovascular, neoplastic, infectious and iatrogenic complications. The development of biotherapies has paved the way for innovative therapeutic strategies, which are associated with toxicities. In this review, we have focused on the scientific and therapeutic changes impacting the management of elderly patients affected by RA, SpA or PsA. A multidimensional health assessment resulting in an integrated therapeutic strategy was identified as a major research direction for improving the management of elderly patients.
10.1093/rheumatology/key165
Holistic care program for elderly patients to integrate spiritual needs, social activity, and self-care into disease management in primary care (HoPES3): study protocol for a cluster-randomized trial.
Trials
BACKGROUND:Strategies to improve the care of elderly, multimorbid patients frequently focus on implementing evidence-based knowledge by structured assessments and standardization of care. In Germany, disease management programs (DMPs), for example, are run by general practitioners (GPs) for this purpose. While the importance of such measures is undeniable, there is a risk of ignoring other dimensions of care which are essential, especially for elderly patients: their spiritual needs and personal resources, loneliness and social integration, and self-care (i.e., the ability of patients to do something on their own except taking medications to increase their well-being). The aim of this study is to explore whether combining DMPs with interventions to address these dimensions is feasible and has any impact on relevant outcomes in elderly patients with polypharmacy. METHODS:An explorative, cluster-randomized controlled trial with general practices as the unit of randomization will be conducted and accompanied by a process evaluation. Patients aged 70 years or older with at least three chronic conditions receiving at least three medications participating in at least one DMP will be included. The control group will receive DMP as usual. In the intervention group, GPs will conduct a spiritual needs assessment during the routinely planned DMP appointments and explore whether the patient has a need for more social contact or self-care. To enable GPs to react to such needs, several aids will be provided by the study: a) training of GPs in spiritual needs assessment and training of medical assistants in patient counseling regarding self-care and social activity; b) access to a summary of regional social offers for seniors; and c) information leaflets on nonpharmacological interventions (e.g., home remedies) to be applied by patients themselves to reduce frequent symptoms in old age. The primary outcome is health-related self-efficacy (using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES-6G)). Secondary outcomes are general self-efficacy (using the General Self-Efficacy Scale (GSES)), physical and mental health (using the Short-Form Health Survey (SF-12)), patient activation (using the Patient Activation Measure (PAM)), medication adherence (using the Medication Adherence Report Scale (MARS)), beliefs in medicine (using the Beliefs About Medicines Questionnaire (BMQ)), satisfaction with GP care (using selected items of the European Project on Patient Evaluation of General Practice (EUROPEP)), social contacts (using the 6-item Lubben Social Network Scale (LSNS-6)), and loneliness (using the 11-item De-Jong-Gierveld Loneliness Scale (DJGS-11)). Interviews will be conducted to assess the mechanisms, feasibility, and acceptability of the interventions. DISCUSSION:If the interventions prove to be effective and feasible, large-scale implementation should be sought and evaluated by a confirmatory design. TRIAL REGISTRATION:German Clinical Trials Register (DRKS), DRKS00015696 . Registered on 22 January 2019.
10.1186/s13063-019-3435-z
[Chronic disease management: mistaken approach in the elderly].
Veras Renato Peixoto
Revista de saude publica
Lifestyle changes, including unhealthy eating habits and high rates of physical inactivity and stress, along with an increase in life expectancy have been accompanied by increasing rates of chronic non-communicable diseases. Chronic diseases are the main causes of death and disability in Brazil. Chronic disease management is one of the most important challenges facing health managers who are constantly seeking interventions and strategies to reduce costs and hospital admissions and to prevent other conditions. However, most existing models of health care have focused exclusively on disease, but it is a mistaken approach. An integrated approach is required to effectively meet patient needs. The purpose of this article was to further discuss policies and strategies for the development of new models of care for the elderly with an emphasis on prevention and resolution actions.
Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
Buja Alessandra,Damiani Gianfranco,Gini Rosa,Visca Modesta,Federico Bruno,Donato Daniele,Francesconi Paolo,Marini Alessandro,Donatini Andrea,Brugaletta Salvatore,Baldo Vincenzo,Donata Bellentani Maria,
PloS one
BACKGROUND:Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group. METHODS:This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. RESULTS:The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds), adults (45-64), and oldest old (+85) than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y), adults (45-64 y), the very old (75-84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. CONCLUSION:Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.
10.1371/journal.pone.0091340
Improving chronic disease management with mobile health platform.
Lee Do-Youn,Bae Sungchul,Song Joon Hyun,Yi Byoung-Kee,Kim Il Kon
Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference
In modern society, aging and chronic disease is becoming common phenomenon due to the increasing numbers of elderly patients. To best treat this growing segment of the population, medical care should be based on constant vital sign monitoring. In this study, we propose a mobile vital sign measurement and data collection system for chronic disease management.. And we implemented a middle ware using Multi-Agent platform in SOS (Self-Organizing System) platform that transmits patient clinical data for services. We also implemented a HL7 messaging interface for interoperability of clinical data exchange. We propose health services on a self-organized software platform.
10.1109/EMBC.2013.6609991
Benefits for elders with vulnerable health from the Chronic Disease Self-management Program (CDSMP) at short and longer term.
Jonker Angèle A G C,Comijs Hannie C,Knipscheer Kees C P M,Deeg Dorly J H
BMC geriatrics
BACKGROUND:When health declines, older persons may benefit from an intervention program that strengthens their self-management and empowers them to keep in control of their own body and life. Therefore we conducted a Randomized Controlled Trial using the Chronic Disease Self-Management Program (CDSMP) in a sample of 169 older persons in frail health and in need of elderly care. METHODS:We assessed psychological coping resources and wellbeing, pre- and posttreatment and at 6-month follow-up, and investigated whether specific subgroups would benefit in particular from the intervention. RESULTS:The CDSMP appeared effective with respect to sense of mastery but only in the lower educated participants (p < .05). Furthermore, the intervention stabilized valuation of life in participants, whereas in the controls valuation of life decreased. The high appreciation score and low drop-out are indicative for the applicability of the CDSMP for this specific target group. CONCLUSIONS:We recommend integration of the ingredients of the program into the daily healthcare practice of professionals working with vulnerable older persons. This would involve professional guidance starting from interpersonal equality and emphasising a persons possibilities given their physical or cognitive limitations. This will help older vulnerable persons to focus on their own attainable goals and to experience being successful. TRIAL REGISTRATION:The trial was registered in the Dutch Trial Register as NTR 1173 at 08-03-2008; 'Is selfmanagement benefical for well-being of average older persons?' http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1173.
10.1186/s12877-015-0090-4
Mobile-Based Technology for the Management of Chronic Diseases in the Elderly: A Feasibility Study.
Shagerdi Ghazal,Ayatollahi Haleh,Oskouie Fatemeh
Current aging science
INTRODUCTION:Population aging and related issues are among the most important challenges in different countries. It seems that the use of remote technology can provide the elderly with better healthcare services and can help them to manage chronic diseases. This research aimed to investigate the experts' views about the feasibility of using mobile-based technology to manage chronic diseases in the elderly. METHODS:This was a survey study which was completed in 2018. The participants were the faculty members of the department of geriatrics across the country (n=33). In order to collect data, two questionnaires were used. The first questionnaire contained questions related to the five dimensions of a feasibility study and the second questionnaire consisted of five open questions about the opportunities, threats, strengths and weaknesses of using mobile-based technology in chronic disease management. The qualitative data were analyzed by using content analysis method and the quantitative data were analyzed by using descriptive statistics. RESULTS:From the participants' perspectives, it was feasible to use mobile-based technology in chronic disease management for elderly people. The mean values for five feasibility dimensions were as follows: ethico-legal dimension (4.09±1.01), scheduling dimension (3.70±1.03), economic dimension (3.47±1.04), operational dimension (3.42±1.12) and technical dimension (3.07±1.27). While such a technology can help increasing the accessibility of healthcare services, raising health literacy, and saving time and costs, the main threats, namely; the misinterpretation of information and the possibility of breeching confidentiality should not be underestimated. CONCLUSION:The results showed that mHealth and remote medical technologies can be used for chronic disease management among elderly people. However, these technologies have some strengths and weaknesses. In order to succeed in the development and implementation of these projects, it is essential to consider probable threats and weaknesses before implementing the applications.
10.2174/1874609812666190621145057
[Nurse-Led Care Models in the Context of Community Elders With Chronic Disease Management: A Systematic Review].
Hsieh Pei-Lun,Chen Ching-Min
Hu li za zhi The journal of nursing
BACKGROUND:Longer average life expectancies have caused the rapid growth of the elderly as a percentage of Taiwan's population and, as a result of the number of elders with chronic diseases and disability. Providing continuing-care services in community settings for elderly with multiple chronic conditions has become an urgent need. PURPOSE:To review the nurse-led care models that are currently practiced among elders with chronic disease in the community and to further examine the effectiveness and essential components of these models using a systematic review method. METHODS:Twelve original articles on chronic disease-care planning for the elderly or on nurse-led care management interventions that were published between 2000 and 2015 in any of five electronic databases: MEDLINE, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus with Full Text, Cochrane Library, and CEPS (Chinese Electronic Periodicals Service）were selected and analyzed systematically. RESULTS:Four types of nurse-led community care models, including primary healthcare, secondary prevention care, cross-boundary models, and case management, were identified. Chronic disease-care planning, case management, and disease self-management were found to be the essential components of the services that were provided. The care models used systematic processes to conduct assessment, planning, implementation, coordination, and follow-up activities as well as to deliver services and to evaluate disease status. The results revealed that providing continuing-care services through the nurse-led community chronic disease-care model and cross-boundary model enhanced the ability of the elderly to self-manage their chronic diseases, improved healthcare referrals, provided holistic care, and maximized resource utilization efficacy. CONCLUSIONS / IMPLICATIONS FOR PRACTICE:The present study cross-referenced all reviewed articles in terms of target clients, content, intervention, measurements, and outcome indicators. Study results may be referenced in future implementations of nurse-led community care models as well as in future research.
10.6224/JN.63.4.35