Community based health interventions 09:00 - 10:30 Friday, 6th July, 2018 1.218 Track Health & social care practices & contexts
150 Impact of Community-Based Continence Promotion on Urinary Incontinence in Older Women: the CACTUS-D International Cluster Randomised Trial
Mrs Eleanor van den Heuvel1, Dr Cara Tannenbaum2,3, Dr Xavier Fritel4, Dr Adrian Wagg5 1Brunel University, London, United Kingdom. 2Université de Montréal, Montreal, Canada. 3Canadian Institutes of Health Research, Montreal, Canada. 4Université de Poitiers, Poitiers, France. 5University of Alberta, Edmonton, Canada
Abstract
Urinary incontinence (UI) is common amongst older women and is known to be associated with social isolation1, depression, and falls 2. But older women fail to seek medical help for UI because many believe incontinence is a normal part of ageing and are not aware cure is possible. The sensitive but non-life- threatening nature of UI means that women tend to delay seeking help until the condition becomes intolerable. CACTUS-D3 tested an evidence-based continence promotion workshop against a control, health workshop in four different localities, France, UK, Quebec and Western Canada. 909 women aged 65-98 years with untreated UI, were recruited from 377 community groups. 751 participants (83%) completed the 1-year follow-up. Urinary symptom improvement was achieved and maintained from 3-months onwards in the intervention group. In 1-year intent-to-treat analyses, 15% of the intervention arm reported clinically important UI improvement compared to 7% of controls. 35% vs 19% reported any improvement . Compared to controls, the intervention group reported a mean 1.28 point (95% CI 1.15 - 1.41) improvement in incontinence-related quality of life at 1-year. There was no reduction in fall rates While the continence promotion was effective across multiple countries and settings more work is needed on how to maintain improvements and how to encourage women to seek medical help if symptoms do not resolve with self-management techniques.
1. Farage MA, et al Arch Gynecol Obstet 2008;277:285-290. 2. Chiarelli PE, et al Aust J Physiother. 2009;55(2):89-95. 3. Tannenbaum, C., et al Trials, 16, 565.
65 The experiences of men with early-stage prostate cancer when receiving information related to a course of radiotherapy in the UK – initial findings of a qualitative study.
Mrs Lynne Gordon, Dr Angela Dickinson, Dr Maxine Offredy University of Hertfordshire, Hatfield, United Kingdom
Abstract
Over 46, 000 UK men are diagnosed with prostate cancer annually and 32% will receive radiotherapy (CRUK, 2017). 54% of cases are in men over the age of 70 years. Despite a large evidence base associated with information in cancer management, to date there appear to be few studies exploring the experiences of men with prostate cancer (MPC) regarding their information needs relating to radiotherapy. A qualitative descriptive study was designed utilising focus groups with therapeutic radiographers (TR) and semi-structured, face-to-face interviews with MPC (either alone or with their spouses). Spousal inclusion was informed by involvement of experts by experience from a cancer support group. This paper presents data from a study in progress. Three focus groups involving 14 TR have been completed. Interviews with MPC and their spouses are ongoing. Qualitative data is being analysed using thematic content analysis. This paper presents emergent findings and highlights differences between patient and TR accounts. Data indicate that TR perceive some patients as being unable to retain and act on specific information given to ensure accurate and reproducible radiotherapy. Emergent data from patient interviews highlighted two main concerns: conflicting information from different health care professionals; lack of communication of information at various points in the radiotherapy referral process. Early findings suggest that effective communication of information potentially impacts on treatment and could affect the outcomes of an individual’s radiotherapy. This will have implications for the work of Therapeutic Radiographers in terms of provision of information to improve patient experience and outcomes. 31 How is Tai Chi received by people living with dementia and their informal carers?
Ms Yolanda Barrado-Martín1,2, Dr Michelle Heward2, Prof Remco Polman3, Dr Samuel R. Nyman1,2 1Psychology Department, Bournemouth University, Bournemouth, United Kingdom. 2Ageing and Dementia Research Centre, Bournemouth University, Bournemouth, United Kingdom. 3School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
Abstract
The aim of this study was to explore the acceptability of a Tai Chi exercise intervention among dyads formed of an older person living with mild-to-moderate dementia and their informal family carer. This study was conducted as part of a pilot intervention phase of a randomised controlled trial, and designed to inform further trial refinements and future exercise research involving people living with dementia. Ten dyads from two localities in the South of England took part in weekly Tai Chi classes over a period of 3-4 weeks, during this time they were also encouraged to practice at home. Field notes were used to record researchers’ observations during the classes and participants and instructors’ feedback at the end of each class. One focus group per locality was held at the end of the last class to gather participants’ views (n=7 dyads). Thematic analysis was used to inductively code the field notes and transcripts. Findings suggest that both members of the dyads were able to follow and enjoy this Tai Chi exercise intervention. Facilitators for the acceptability of the intervention were the socialising component at the end of each class, the skills and personality of the instructor and the discovery of a new pleasurable activity to practise together. The main barrier for their acceptability of the intervention was difficulty following the booklet provided to support their home practice. A dyadic approach to the delivery of exercise interventions should be considered for people with dementia and their informal carers. 58 Outcome of participating in Community Care Centers among the older people in Taiwan
Mrs Yu-Hsien Chiang, Dr Hui-Chuan Hsu Department of Health Care Administration, Asia University, Taichung, Taiwan
Abstract
Purpose: The Community Care Centers have been widely spread in all the districts/towns in Taiwan which provide health promotion and social activities in the communities for the community-based older people since 1995. The purpose of this study was to describe the status of the activity delivery and management of the Community Care Centers (CCCs) for the older people and to explore the outcome of the activity participation in health and health literacy. Methods: The sample was from the CCCs and their participants in Taichung, Taiwan. Twenty-six CCCs participated in the study. The managers as well as the older participants of CCCs were interviewed by face-to-face interviews. In total, 417 older people participants completed the face-to-face interviews. Descriptive analysis and logistic regression were conducted for analysis. Results: The participants reported that self-reported health, sleeping quality, memory, family relationship, care for health, and health literacy were improved after they participated in the program. Participating in more programs or more frequently were related to better self-rated health, sleeping quality and memory. In addition, the laissez-faire management style and the relationship-oriented management style were related to better health outcome compared, while task-oriented management was related to worse outcome. Conclusion: Participation in the CCCs may improve health and social participation for the community-based older people. The employment of full-time and paid staff can increase the health changes after the participation of the elderly, and the effect toward the management style involvement may reflect the ability of running CCCs. The policy suggestions are provided. 365 Detecting, addressing and preventing malnutrition: What do we know about the nutritional status of older people presenting to a meals on wheels service?
Mrs Michelle Dewar1,2, Dr Angela Dickinson3, Mr Nigel Smeeton3 1Hertfordshire Independent Living Service, Letchworth,Herts, United Kingdom. 2CLAHRC NIHR Fellowship, East of England, United Kingdom. 3CRIPACC, University of Hertfordshire, Hertfordshire, United Kingdom
Abstract
Most malnutrition in older people occurs in the community. Support services, e.g. meals on wheels (MoW), play an essential role in the prevention and treatment of malnutrition. MoW services are in decline, but we know very little about how they support the nutrition and wellbeing of those using MoW services in the UK. Hertfordshire Independent Living Service (HILS) is a MoW provider, unique in the UK in offering face-to-face nutrition and wellbeing screening. This study reports on the nutrition and wellbeing status of clients receiving input from the nutrition service and uses this data to assess the effectiveness of the service.
All clients receiving MOW are invited to have a nutrition and wellbeing check (400+ to date). Those with nutritional concern are prioritised. This includes assessment of nutritional status using the validated Malnutrition Universal Screening Tool, as well as other measures around wellbeing and frailty. A proportion of clients have been followed up at 3, 6 and 12 months and this data will be reviewed to assess change in nutritional status over time.
The nutrition service at HILS is actively identifying people at risk of malnutrition and other health issues, who might otherwise not have been picked up. Analysis of data from this unique dataset, including loneliness, nutritional status and frailty will be presented.
By offering a nutrition service within a MoW service, malnutrition and other health issues can be identified early, potentially delaying or preventing the need of support from acute health services and social care. 120 PATIENT PERSPECTIVES IN GEOGRAPHIC ATROPHY (GA)
Dr Sarah Barnes, Dr Jill Carlton, Dr Annette Haywood University of Sheffield, Sheffield, United Kingdom
Abstract
Age-related macular degeneration (AMD) is the major cause of blindness for the older population in the developed world. In later stages the disease may progress to geographic atrophy (GA). This progressive degenerative disease causes loss of visual function but there are currently no approved therapeutic treatments for GA. Management of the condition is through supportive care, ie referral to low vision clinics for assessment and supply of equipment and, in some situations, notification to social services.
This qualitative study aimed to develop an understanding of the impact GA has upon quality of life for affected individuals and their families.
Two focus groups were carried out with a purposive sample of older people with GA attending a hospital eye clinic. The groups were set up to align on the basis of visual acuity as it was acknowledged that it may be distressing for participants with good levels of vision to hear how people with poorer vision have been affected. Data were analysed thematically using NVivo10.
Analysis showed that participants were experiencing a variety of symptoms, and understanding of their condition could be improved. Key emergent themes were: the negative impact of GA on activities, in particular navigating and reading; feelings and emotions; relationships and informal support; accessing formal support and; information needs.
Signposting to charities and support groups is recommended, however variable access to services is noted across populations within the UK. This exploratory work will help inform future outcome measures for AMD interventions.
[Project funded by Roche Products Limited.]