Lay perspectives of successful ageing: a systematic review and meta-ethnography

Cosco, Theodore D.; Prina, Matthew; Perales, Jaime; Stephan, Blossom C M; Brayne, Carol

doi:10.1136/bmjopen-2013-002710

Cited by 173 publications

(167 citation statements)

References 45 publications

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“…In order to preserve self-esteem, the old-old might better adopt worldviews that emphasize alternative resources for self-esteem and meaning in old age, alongside the acceptance of the inevitable deterioration in old age (Cosco et al 2013;Kahana et al 2012) (see Fig. 4.1).…”

Section: Discussionmentioning

confidence: 99%

Origins of Ageism at the Individual Level

Lev

Wurm

Ayalon

2018

International Perspectives on Aging

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Section: Discussionmentioning

confidence: 99%

Origins of Ageism at the Individual Level

Lev

Wurm

Ayalon

2018

International Perspectives on Aging

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“…In a recent review of operational definitions of successful ageing, Cosco et al (2014a) revealed more than 100 unique operationalisations. A subsequent systematic review by the same authors revealed that these perspectives of successful ageing from researchers did not align with those of older adults themselves (Cosco et al 2013(Cosco et al , 2014b. Laypersons suggest that a focus on psychosocial components -or more subjective components -are integral to healthy ageing whilst researchers focused more on biomedical -or more objective -components.…”

Section: Healthy Ageingmentioning

confidence: 99%

Healthy ageing, resilience and wellbeing

Cosco

Howse

Brayne

2017

Epidemiol Psychiatr Sci

207

100

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The extension of life does not appear to be slowing, representing a great achievement for mankind as well as a challenge for ageing populations. As we move towards an increasingly older population we will need to find novel ways for individuals to make the best of the challenges they face, as the likelihood of encountering some form of adversity increases with age. Resilience theories share a common idea that individuals who manage to navigate adversity and maintain high levels of functioning demonstrate resilience. Traditional models of healthy ageing suggest that having a high level of functioning across a number of domains is a requirement. The addition of adversity to the healthy ageing model via resilience makes this concept much more accessible and more amenable to the ageing population. Through asset-based approaches, such as the invoking of individual, social and environmental resources, it is hoped that greater resilience can be fostered at a population level. Interventions aimed at fostering greater resilience may take many forms; however, there is great potential to increase social and environmental resources through public policy interventions.

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“…20 Most studies that were identified in our reviews had limited or low service user involvement in intervention development. Although much research has been undertaken with general older populations exploring their perspectives on successful ageing, 174 we did not identify any qualitative studies of older adults with mild frailty, eliciting their views on promoting health and well-being in the context of experiencing symptoms of frailty (e.g. lack of energy, feeling 'slowed up').…”

Section: Intervention Development: Identifying Effective Content For mentioning

confidence: 99%

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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Lay perspectives of successful ageing: a systematic review and meta-ethnography

Cited by 173 publications

References 45 publications

Origins of Ageism at the Individual Level

Origins of Ageism at the Individual Level

Healthy ageing, resilience and wellbeing

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

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