Abstract:Objective: To synthesize older adults’ experiences and perceptions of goal setting and pursuit within health systems. Methods: Six databases were searched to May 2019 using a combination of MeSH and free text terms. Included papers were written in English and reported original qualitative research for participants aged 65 years and older. Participant quotes from the results sections of included studies were gathered for thematic analysis and synthesis. Results: Initial search yielded 9,845 articles, and 134 we… Show more
“…However, there are barriers to implementing goal setting and pursuit in practice. In the systematic review by Baker and colleagues, several challenges were discussed for older adults' goal setting in the hospital, such as confusion with terminology and other person‐level factors (Baker et al., 2021). Other research within physiotherapy corroborates challenges with goal setting, and in particular, shared goal setting (Baker et al., 2001; Lloyd et al., 2014).…”
Purpose: Reablement is a health and social model of care gaining international prominence. It is included in some publicly funded healthcare systems in Australia, Canada, United Kingdom, Norway, Sweden and other European countries. To advance reablement research and practice, we aimed to synthesize expert opinion on opportunities and challenges to delivering care with this model.
Methods:We invited authors of reablement publications and other experts from the field to take part in a three-step online concept mapping exercise: (i) brainstorming statements based on a focus prompt; followed by (ii) sorting and (iii) rating statements. We invited 63 participants, of whom 19 participants generated 114 statements. Two authors reviewed each statement independently then met three times to determine one main idea/statement and removed unrelated or duplicate ideas. The research team used concept mapping software and online and email discussion to generate clusters or groups of determinants.Results: There were 58 statements for sorting and rating; 11 and 12 participants completed the sorting and rating steps, respectively. The five clusters were person and caregiver elements for participation; key reablement components for success; reablement content and delivery; organizational factors; and provider beliefs and training. Statements rated as both highly important and feasible to implement into practice were generally captured under the domains of goal setting and pursuit and person-centred care.
Conclusion:These results generate hypotheses for future research and practice in reablement for older adults.
“…However, there are barriers to implementing goal setting and pursuit in practice. In the systematic review by Baker and colleagues, several challenges were discussed for older adults' goal setting in the hospital, such as confusion with terminology and other person‐level factors (Baker et al., 2021). Other research within physiotherapy corroborates challenges with goal setting, and in particular, shared goal setting (Baker et al., 2001; Lloyd et al., 2014).…”
Purpose: Reablement is a health and social model of care gaining international prominence. It is included in some publicly funded healthcare systems in Australia, Canada, United Kingdom, Norway, Sweden and other European countries. To advance reablement research and practice, we aimed to synthesize expert opinion on opportunities and challenges to delivering care with this model.
Methods:We invited authors of reablement publications and other experts from the field to take part in a three-step online concept mapping exercise: (i) brainstorming statements based on a focus prompt; followed by (ii) sorting and (iii) rating statements. We invited 63 participants, of whom 19 participants generated 114 statements. Two authors reviewed each statement independently then met three times to determine one main idea/statement and removed unrelated or duplicate ideas. The research team used concept mapping software and online and email discussion to generate clusters or groups of determinants.Results: There were 58 statements for sorting and rating; 11 and 12 participants completed the sorting and rating steps, respectively. The five clusters were person and caregiver elements for participation; key reablement components for success; reablement content and delivery; organizational factors; and provider beliefs and training. Statements rated as both highly important and feasible to implement into practice were generally captured under the domains of goal setting and pursuit and person-centred care.
Conclusion:These results generate hypotheses for future research and practice in reablement for older adults.
“…Of note, the MCRCs did not substantially change over time in all the CR outcomes, except for Borg-F, as assessed during the exercise tolerance test. It is difficult to explain this result; it may be associated with the changes in the patients' characteristics observed over time, with a progressive increase in the referral to CR of older patients with more comorbidities less responsive to perceived fatigue [25].…”
Aims: Cardiac rehabilitation (CR) has proven to be effective and beneficial in middle-aged and older patients. However, solid data in large cohorts of elderly individuals are yet to be explored. This retrospective study investigated the general characteristics, outcomes, and the level of response of patients referred to CR over 13 consecutive years. Methods: We reviewed the medical records of patients admitted to Villa Pineta Rehabilitation Hospital for exercise-based CR from 2006 to 2018. The patients’ baseline characteristics and changes following CR in an upper-limb weightlifting test (ULW), 30-s sit-to-stand test (30STS), and the 6-min walking test (6MWT) with associated Borg-related dyspnea (D) and fatigue (F) were collected. We also calculated the number of individuals that reached the minimal clinically relevant change (MCRC) following CR for each outcome. Results: One thousand five hundred and fifty-one patients (70.2 ± 9.7 years, 66% men) with complete datasets were included in the analysis. Coronary artery bypass graft and cardiac valve replacement surgery were the most frequent surgical procedures leading to CR referral (41.1% and 35.8%, respectively). The patients’ age (p = 0.03), number of total comorbidities (p < 0.0001), and post-surgical complications (p = 0.02) significantly increased over time. In contrast, the average absolute changes in ULW, 30STS, and 6MWT with associated D and F, and the proportion of patients that reached their respective MCRC, remained constant over the same period. Conclusion: The patients admitted to exercise-based CR were older and had more comorbidities and complications over time. The outcomes, however, were not influenced in terms of the absolute change or clinically meaningful response.
“…Goal setting is a method for identifying and negotiating goals and can inform the development of strategies including managing symptoms, therapy interventions, functional status or return to social activities (Levack et al., 2015). Goal setting provides an opportunity for shared decision‐making where the person discusses their current situation and expectations with a health professional, who in turn provides expert advice on options and strategies available (Baker et al., 2020). Widely used goal setting tools and approaches include SMART goals (specific, measurable, attainable, relevant and time bound), RUMBA (relevant, understandable, measurable, behavioural and achievable) (Levack et al., 2015), and the Five Principles of Successful Goal Setting (commitment, clarity, challenge, complexity and feedback) (Locke & Latham, 1990).…”
Section: Introductionmentioning
confidence: 99%
“…Although there is a strong theoretical understanding of the importance of goal setting in W&R programs and the benefits of W&R approaches are well documented and supported (see Clotworthy et al., 2020; ReAble Network, 2019; Nous Group, 2018; Tuntland et al., 2016), few studies explore the older person's experience from their perspective (Baker et al., 2020). This study aims to explore the experience of older people in a W&R programme, supplemented by the perspective of health professionals trained in the approach, to address the research question ofWhat was the experience of older people in a wellness and reablement programme and how did it impact on their health and wellbeing?…”
Section: Introductionmentioning
confidence: 99%
“…Although there is a strong theoretical understanding of the importance of goal setting in W&R programs and the benefits of W&R approaches are well documented and supported (see Clotworthy et al, 2020;ReAble Network, 2019;Nous Group, 2018;Tuntland et al, 2016), few studies explore the older person's experience from their perspective (Baker et al, 2020). This study aims to explore the experience of older people in a W&R programme, supplemented by…”
Australian health and aged care reforms mandate a wellness and reablement (W&R) approach with services and the workforce needing to adjust their way of working with older people, to actively promote independence and participation in life's activities. Studies exploring the older person's perspective are sparse. This study aims to understand the older person's experience of a W&R approach, supplemented with experiences of staff trained in the approach. The study evaluates a W&R approach implemented across three community-based sites of a large Australian aged care provider. Staff from participating sites underwent training and were asked to use a W&R approach with at least one older person. Eighteen older people aged 65+ were engaged in the 4-month programme. Semi-structured interviews with older people and staff were conducted on completion of the programme. The W&R approach showed variable benefits and experiences of older people related to goal setting and outcomes. Overall, older people were unfamiliar with goal setting or displayed negative attitudes. Negative emotional responses to health decline and ageing, such as apathy, frustration, embarrassment and sense of helplessness, were identified as barriers to goal pursual. In contrast, enabling factors, such as assistive equipment, staff and social connection, triggered positive emotional responses, which acted as protective factors and enhanced goal pursual. Staff knowledge and understanding of the W&R approach also influenced older people's experience and outcomes. These findings recommend a stronger focus on the social and emotional aspects of W&R and codeveloping goals in line with the older person's sense of wellbeing. This approach supports the multiple dimensions of W&R and aligns with principles of positive and healthy ageing. Additional training for staff should be provided, with ongoing mentoring and support from W&R champions. Ensuring that goals are meaningful and valuable to individual older people will enhance successful goal pursual and improve outcomes.
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