District nurses’ experiences of preventive home visits to 75-year-olds in Stockholm: a qualitative study

Lagerin, Annica; Törnkvist, Lena; Hylander, Ingrid

doi:10.1017/s1463423615000560

Cited by 10 publications

(26 citation statements)

References 35 publications

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“…Consistent with our findings, communication skills and building a positive relationship are seen by older people as a vital part of their services 191,193,194 and have been emphasised in other participatory design processes around frailty prevention. 195 Addressing cognitive, social, psychological and home environment dimensions within frailty prevention services have been advocated by stakeholders 170 and physical and occupational therapists.…”

Section: Discussionsupporting

confidence: 89%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

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Background Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. Objectives (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Design Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Intervention development Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Feasibility RCT Single-blind RCT, individually randomised to ‘HomeHealth’ or treatment as usual (TAU). Setting Community settings in London and Hertfordshire, UK. Participants A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Main outcome measures Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. Results We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Conclusions Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. Future work A large, definitive RCT of the HomeHealth service is warranted. Study registration This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.

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Section: Discussionsupporting

confidence: 89%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

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“…In Norway, structural barriers limit cooperation between PHV services and GPs, leading to missed opportunities for longitudinal PHV services with competent nurses to add the benefits of preventive measures for their users. was identified as essential in qualitative PHV studies 12,15,22 , as well as other interventions to older people 41,42 . The time for users to judge the nurses' personal and professional trustworthiness varied, and some users needed several visits before they engaged in constructive collaborations.…”

Section: Discussionmentioning

confidence: 99%

“…While early PHV interventions had a predominant focus on disease prevention 7,8 , later PHV reviews display a more varied and broader focus 6,9 . Recent studies demonstrate that Scandinavian PHVs often include disease prevention as well as support for various aspects of subjective health and coping, and thus reflect a comprehensive understanding of health and health promotion [10][11][12] . In Scandinavia, a common approach is to offer annual PHVs to a general population of older people after a model from Denmark, in which annual PHVs from the age of 75 were legislated from 1996 4,5 .…”

Section: Introductionmentioning

confidence: 99%

‘A longitudinal room of possibilities’ – perspectives on the benefits of long-term preventive home visits: A qualitative study of nurses’ experiences

Tøien

Bjørk

Fagerström

2019

Nordic Journal of Nursing Research

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Preventive home visits carried out by healthcare professionals are intended to promote the health and independence of home-dwelling older persons and to prevent functional decline. The aim of this study was to describe nurses’ experiences of the benefits from long-term follow up with annual preventive home visits to older people in a Norwegian context. We conducted semi-structured interviews with nine nurses who performed the service. Manifest and latent content analysis revealed benefits within three themes: sustained ability to live independently and thrive despite age-related changes, eased transition to other healthcare services, and improved healthcare service planning. Two headlines describe the longitudinal processes involved in the creation of benefits: ‘The processes of establishing, sustaining, and widening a longitudinal room of possibilities’, and ‘The individualized health-promoting processes – the ongoing gardening work. Professional, contextual and structural factors influenced the nurses’ ability to support older persons’ changing needs during the aging process and thus their health and independence.

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“…In 2006, the Executive Board of the Stockholm County Council decided to implement preventive home visits for 75-year-olds by DNs [7]. As the main responsibility of DNs is to prevent diseases and promote health in the population, preventive home visits were regarded as a natural part of the DNs' professional tasks [8]. A study that investigated the selfreported health conditions of 75-year-olds and effects before and after a preventive home visit by a DN showed that nearly 60% accept the offer of a preventive home visit.…”

Section: Introductionmentioning

confidence: 99%

“…This work takes place both at health-care centres and in the patients' homes, for example during preventive home visits to 75-year-olds [6,7]. During these one-hour visits, DNs aim to establish a trustful contact with the older person, conduct a structured interview, make an overall assessment of the person's health and environment, and propose health-promoting activities and follow-up measures as needed [8].…”

Section: Introductionmentioning

confidence: 99%

Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study

Lagerin

Törnkvist

Nilsson

et al. 2017

Scand J Public Health

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Aims: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Methods: Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. Results: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. Conclusions: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses’ role in continuing to promote safe medication management at higher ages.

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District nurses’ experiences of preventive home visits to 75-year-olds in Stockholm: a qualitative study

Cited by 10 publications

References 35 publications

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

‘A longitudinal room of possibilities’ – perspectives on the benefits of long-term preventive home visits: A qualitative study of nurses’ experiences

Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study

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