Nurse Care Coordination and Technology Effects on Health Status of Frail Older Adults via Enhanced Self-Management of Medication

Marek, Karen Dorman; Stetzer, Frank; Ryan, Polly; Bub, Linda; Adams, Scott; Schlidt, Andrea Matovina; Lancaster, Rachelle J.; O’Brien, Anne-Marie

doi:10.1097/nnr.0b013e318298aa55

Cited by 68 publications

(106 citation statements)

References 39 publications

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“…We included 19 studies of people who were frail or at risk of frailty: 16 RCTs, 12,13,[56][57][58][59][60][61][62][63][64][65][66][67][68][69] two clusters RCTs 48,70 and one pseudocluster RCT 71 (see Report Supplementary Material 3 for study characteristics). Most (n = 16) compared one intervention to control, with three three-arm trials.…”

Section: Resultsmentioning

confidence: 99%

“…48,63,64 Most interventions (n = 11/22) targeted a single behaviour, 12,[61][62][63][64][66][67][68]70,71 while nine targeted two or three behaviours 13,[56][57][58][59]65,69 and two targeted four or more behaviours. 48, 60 The behaviours most commonly targeted were medication adherence or management (n = 16), 13,48,56,[58][59][60][61][63][64][65][66]68,69 physical activity (n = 11) 12,13,48,56,57,59,60,65,70 and diet (n = 8), 13,48,56,57,60,69...…”

Section: Behavioural Targetsmentioning

confidence: 99%

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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: Resultsmentioning

confidence: 99%

Section: Behavioural Targetsmentioning

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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“…A descriptive cross-sectional design was employed in this secondary analysis of data from the Home Care Medication Management for the Frail Elderly study (R01-NR008911) (K. D. Marek et al, 2013). The primary study used a longitudinal repeated measures design, enrolling and randomly assigning participants discharged from three home healthcare agencies in a large Midwestern urban region of the United States.…”

Section: Methodsmentioning

confidence: 99%

Medication Regimens of Frail Older Adults After Discharge From Home Healthcare

Lancaster¹,

Marek²,

Bub

et al. 2014

Home Healthcare Nurse

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The purpose of this study was to examine the number and types of discrepancy errors present after discharge from home health care in older adults at risk for medication management problems following an episode of home healthcare. More than half of the 414 participants had at least one medication discrepancy error (53.2%, n=219) with the participant’s omission of a prescribed medication (n=118, 30.17%) occurring most frequently. The results of this study support the need for home health clinicians to perform frequent assessments of medication regimens to ensure that the older adults are aware of the regimen they are prescribed, and have systems in place to support them in managing their medications.

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“…Examples of reminder devices to take medications and which may provide intervention techniques include machines that dispense medication, voice-mail reminders, video-telephone reminders, automated telephone calls, and medication caps equipped with digital alarm clocks [93][94][95][96]. Automated medication dispensers give a patient access to the correct medication at the prescribed time.…”

Section: Ambient Assistive Technology For Wrong Self-medication Managmentioning

confidence: 99%

“…Automated medication dispensers [93][94][95][96], HealthWatch, Beep N Tel [67] Dispense medication at preprogrammed intervals.…”

Section: System Monitoring and Detection Of Medication Adherence Intementioning

confidence: 99%

Ambient Technology to Assist Elderly People in Indoor Risks

Yared

Abdulrazak

2016

Computers

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While elderly people perform their daily indoor activities, they are subjected to several risks. To improve the quality of life of elderly people and promote healthy aging and independent living, elderly people need to be provided with an assistive technology platform to rely on during their activities. We reviewed the literature and identified the major indoor risks addressed by assistive technology that elderly people face during their indoor activities. In this paper, we identify these risks as: fall, wrong self-medication management, fire, burns, intoxication by gas/smoke, and the risk of inactivity. In addition, we discuss the existing assistive technology systems and classify the risk detection algorithms, techniques and the basic system principles and interventions to enhance safety of elderly people.

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Nurse Care Coordination and Technology Effects on Health Status of Frail Older Adults via Enhanced Self-Management of Medication

Cited by 68 publications

References 39 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

Medication Regimens of Frail Older Adults After Discharge From Home Healthcare

Ambient Technology to Assist Elderly People in Indoor Risks

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