No Place Like Home? Surveillance and What Home Means in Old Age.
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ABSTRACT:
SUBMITTER: Mortenson WB
PROVIDER: S-EPMC5567666 | biostudies-other | 2016 Mar
REPOSITORIES: biostudies-other
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Project description:With the present research, we further exploited the potential of the ENABLE-AGE Project, more precisely the Swedish and German data. We hypothesised that the magnitude of accessibility problems (MAP) in the home environment and external housing-related control beliefs (HCB) play a substantial role for a range of outcomes related to quality of life. Our sample at T1 consisted of 847 single-living and community-dwelling individuals aged between 80 and 89 years, from urban regions in Sweden and Germany, 636 of whom were re-assessed 1 year later. MAP was measured with the Housing Enabler instrument, while external HCB assessment was based on a questionnaire proved useful in earlier research. Outcomes were assessed with established measures of ADL independence/dependence, general well-being, positive and negative affect and depression. Cross-sectional regressions underscored that MAP and external HCB were rather consistently associated with outcomes, with MAP being more strongly associated with ADL independence/dependence and external HCB more strongly with well-being related outcomes. Furthermore, significant and marginally significant interaction terms underscored that being high in external HCB in the situation of large MAP was linked with more negative outcomes, while external HCB did not play a role in the situation of small MAP. In the longitudinal regression analysis, MAP at T1 was predictive for T1-T2 change in ADL independence/dependence and depression, while external HCB did not show substantial relations with any change in outcomes. Our study underlines and qualifies substantial relations between objective and perceived person-physical environment measures and a range of outcomes. Such evidence is required to further improve housing-oriented prevention and intervention strategies in advanced old age.
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Project description:Falls in older people are a major public health issue, but the underlying causes are complex. We sought to evaluate the effectiveness of preventive home visits as a multifactorial, individualized strategy to reduce falls in community-dwelling older people.Data were derived from a prospective randomized controlled trial with follow-up examination after 18 months. Two hundred and thirty participants (?80 years of age) with functional impairment were randomized to intervention and control groups. The intervention group received up to three preventive home visits including risk assessment, home counseling intervention, and a booster session. The control group received no preventive home visits. Structured interviews at baseline and follow-up provided information concerning falls in both study groups. Random-effects Poisson regression evaluated the effect of preventive home visits on the number of falls controlling for covariates.Random-effects Poisson regression showed a significant increase in the number of falls between baseline and follow-up in the control group (incidence rate ratio 1.96) and a significant decrease in the intervention group (incidence rate ratio 0.63) controlling for age, sex, family status, level of care, and impairment in activities of daily living.Our results indicate that a preventive home visiting program can be effective in reducing falls in community-dwelling older people.
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Project description:BackgroundSince older adults spend much time in their home environment (HE), frailty may occur as a consequence of a maladaptation to the HE. The aim of this study was to describe the prevalence of frailty in the very old population of North Rhine-Westphalia, and to examine the association between the HE and the frailty levels of these individuals.MethodsData from a cross-sectional representative study were used, including data on 1577 community-dwelling individuals and nursing home residents aged ≥ 80 years. Objective and subjective HE aspects were included. Frailty was defined according to four criteria: exhaustion, unintentional weight loss, weakness, and low physical activity. Adjusted multinomial regression modelling was used to analyze the link between the HE and frailty levels.ResultsOf the very old individuals, 24.3% were robust, 57.0% were prefrail, and 18.7% were frail. Adjusting for relevant sociodemographic and health characteristics, being not closely attached to the HE was linked with an increased probability of being prefrail and frail. An improvement of the residential area was associated with a decrease in odds of being frail. Living in communities with less than 50,000 and with 100,000-499,999 inhabitants decreased the odds of being frail.DiscussionFrailty prevalence is shown to be higher in the very old population than in the younger age groups in Germany. Early identification of frailty and tailored interventions focused on improving objective and subjective attributes of the HE are needed to reduce the risk of frailty.
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