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Results 21 - 30 of 664

Economic evaluation of a falls prevention exercise program among people With Parkinson's disease

FARAG Inez, et al
2016

Objective: The aim of this study was to determine the cost‐effectiveness of a 6‐month minimally supervised exercise program for people with PD. Methods: An economic analysis was conducted alongside a randomized, controlled trial in which 231 people age 40 years and over with PD were randomized into a usual care control group or an exercise group. Cost‐effectiveness was estimated using incremental cost per fall prevented (using falls calendars) as the primary analysis and cost per extra person avoiding mobility deterioration (defined as an improvement or no change in the 12‐point Short Physical Performance Battery Score between baseline and 6 month). A cost‐utility analysis using the Short Form‐6D was also performed. Uncertainty was represented using cost‐effectiveness scatter plots and acceptability curves. Planned subgroup analyses for the low‐disease‐severity group were also undertaken. Results: All results are reported in Australian dollars ($A). The average cost of the intervention was $A1,010 per participant. Incremental cost‐effectiveness of the program relative to usual care was $A574 per fall prevented, $A9,570 per extra person avoiding mobility deterioration, and $A338,800 per quality‐adjusted life year gained. The intervention had an 80% probability of being cost‐effective, relative to the control, at a threshold of $A2,000 per fall prevented. Subgroup analyses for the low‐disease‐severity group indicate the program to be dominant, that is, less costly and more effective than usual care for all health outcomes. Conclusion: The exercise intervention appeared cost‐effective with regard to fall prevention in the whole sample and cost saving in the low disease severity group, when compared with usual care.

Efficacy and generalizability of falls prevention interventions in nursing homes: a systematic review and meta-analysis

GULKA Heidi J, et al
2020

Objectives: To determine the efficacy of fall intervention programs in nursing homes (NHs) and the generalizability of these interventions to people living with cognitive impairment and dementia. Design: Systematic review and meta-analysis. Setting and Participants: NH residents (n = 30,057) living in NHs defined as residential facilities that provide 24-hours-a-day surveillance, personal care, and some clinical care for persons who are typically aged ≥65 years with multiple complex chronic health conditions. Methods: Meta-analysis of falls prevention interventions on number of falls, fallers, and recurrent fallers. Results: Thirty-six studies met inclusion criteria for the systematic review. Overall, fall prevention interventions reduced the number of falls [risk ratio (RR) = 0.73, 95% confidence interval (CI) = 0.60-0.88], fallers (RR = 0.80, 95% CI = 0.72-0.89), and recurrent fallers (RR = 0.70, 95% CI = 0.60-0.81). Subanalyses revealed that single interventions have a significant effect on reducing fallers (RR = 0.78, 95% CI = 0.69-0.89) and recurrent fallers (RR = 0.60, 95% CI = 0.52-0.70), whereas multiple interventions reduce fallers (RR = 0.69, 95% CI = 0.39-0.97) and multifactorial interventions reduce number of falls (RR = 0.65, 95% CI = 0.45-0.94). Conclusions and Implications: Exercise as a single intervention reduced the number of fallers and recurrent fallers by 36% and 41%, respectively, in people living in NHs. Other effective interventions included staff education and multiple and multifactorial interventions. However, more research on exercise including people with cognitive impairment and dementia is needed to improve the generalizability of these interventions to the typical NH resident.

Community exchange and time currencies: a systematic and in-depth thematic review of impact on public health outcomes

LEE C, et al
2020

Objectives: Austerity in government funding, and public service reform, has heightened expectations on UK communities to develop activities and resources supportive of population health and become part of a transformed place-based system of community health and social care. As non-monetary place-based approaches, Community Exchange/Time Currencies could improve social contact and cohesion, and help mobilise families, neighbourhoods, communities and their assets in beneficial ways for health. Despite this interest, the evidence base for health outcomes resulting from such initiatives is underdeveloped. Study design: A systematic review. Methods: A literature review was conducted to identify evidence gaps and advance understanding of the potential of Community Exchange System. Studies were quality assessed, and evidence was synthesised on ‘typology’, population targeted and health-related and wider community outcomes. Results: The overall study quality was low, with few using objective measures of impact on health or well-being, and none reporting costs. Many drew on qualitative accounts of impact on health, well-being and broader community outcomes. Although many studies lacked methodological rigour, there was consistent evidence of positive impacts on key indicators of health and social capital, and the data have potential to inform theory. Conclusions: Methodologies for capturing impacts are often insufficiently robust to inform policy requirements and economic assessment, and there remains a need for objective, systematic evaluation of Community Exchange and Time Currency systems. There is also a strong argument for deeper investigation of ‘programme theories’ underpinning these activities, to better understand what needs to be in place to trigger their potential for generating positive health and well-being outcomes.

Regular doses of nature: the efficacy of green exercise interventions for mental wellbeing

ROGERSON Mike, et al
2020

This study investigated the efficacy of medium-term Green Exercise (GE; being physically active within a natural environment) interventions for improving wellbeing, by pooling data collected at the start and end of participants’ engagement with a range of GE interventions. Hypotheses were that (i) interventions would show good efficacy for improving wellbeing in the overall sample; (ii) compared to participants reporting ‘average to high’ wellbeing at the start of their project, participants with ‘low’ starting wellbeing would report greater improvements post-intervention; and (iii) improvements would significantly differ between age groups. The pooled dataset was categorized in line with UK norms (n = 318) and analyzed using a standardized meta-analysis approach. Effect size was large: g = 0.812 (95% CI [0.599, 1.025]), and differences in wellbeing changes associated with project duration, age or sex were not statistically significant. Compared to those reporting ‘average-high’ starting wellbeing, participants reporting ‘low’ starting wellbeing exhibited greater improvements (BCa 95% CI [−31.8, −26.5]), with 60.8% moving into the ‘average-high’ wellbeing category. GE can play an important role in facilitating wellbeing and can provide alternative pathways for health and social care practice. Public health commissioners should consider integrating such interventions for patients experiencing low wellbeing or associated comorbidities.

The effectiveness of community-based social innovations for healthy ageing in middle- and high-income countries: a systematic review

GHIGA Ioana, et al
2020

Objectives: Community-based social innovations (CBSIs) are one type of intervention that may help to address the complex needs of ageing populations globally. The aim of this research was to assess evidence for the effectiveness and cost-effectiveness of CBSIs involving in such contexts. Methods: This study conducted a systematic review of CBSIs for healthy ageing in middle- and high-income countries, including any CBSI that aimed to empower people aged 50 and over by motivating them to take initiative for their own health and wellbeing. The protocol was registered with Prospero (CRD 42016051622). A comprehensive search was conducted in 15 academic databases and advanced search in Google. This study included published studies from 2000 onwards in any language. Exploratory meta-analysis was conducted for quantitative studies reporting similar outcomes, and qualitative studies were analysed using thematic analysis. Narrative synthesis was conducted. Searches yielded 13,262 unique hits, from which 44 papers met the inclusion criteria. Results: Most studies reported interventions having positive impacts on participants, such as reduced depression, though the majority of studies were classified as being at medium or high risk of bias. There was no evidence on costs or cost-effectiveness and very little reporting of outcomes at an organization or system level. CBSIs have the potential for positive impacts, but with nearly half of studies coming from high-income urban settings (particularly the United Kingdom and the United States of America), there is a lack of generalizability of these findings. Conclusions: This research highlights the need to improve reporting of CBSIs as complex interventions, and for improved conceptualization of these interventions to inform research and practice.

Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England

MUNFORD Luke Aaron, et al
2020

Objectives: Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. This study uses longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care. Design: Prospective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation. Setting: Participation in community asset facilities. Costs of primary and secondary care. Participants 4377 older people with long-term conditions. Intervention Participation in community assets. Primary and secondary outcome measures Quality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits. Results: Starting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £−96 (95% CI £−512 to £321) at 6 months; £−283 (95% CI £−926 to £359) at 12 months; and £−453 (95% CI £−1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of −0.102 (95% CI −0.173 to −0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months. Conclusions: Participation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.

Hear and now: the impact of an intergenerational arts and health project on participant wellbeing

JENKINS Lindsay, FARRER Rachel, AUJLA Imogen
2020

This research explores the impact that an intergenerational arts and health project can have upon wellbeing, with a particular focus on the benefits that intergenerational practice can provide in relation to quality of life, affect, and social inclusion. It is based on Hear and Now, an award-winning, intergenerational community arts project developed by the Philharmonia Orchestra and Orchestras Live in Bedford, which brought together older adults living with dementia and young people. The study looked at the impact on the participant end users, and also the experiences of their carers and the artists and support staff who facilitated the project. Data were collected through observations of the workshops and focus groups. Researchers used the PERMA model of wellbeing to reflect on the impact of the project. The results found that participants reported: many positive emotions; a high level of engagement; the creation of positive relationships and new connections; that the project had meaning and that they felt of value; and an overall sense of achievement and accomplishment. The findings highlight the holistic impact of intergenerational arts and its ability to create a sense of belonging and purpose that unites different sectors of the community. The report also highlights key learning for future projects.

Evaluating Ageing Better Isle of Wight: participant journeys

NATIONAL DEVELOPMENT TEAM FOR INCLUSION
2020

This research report looks at how the Ageing Better Isle of Wight Programme, known as Age Friendly Island, is working to reduce isolation by exploring how older people access, participate and move between the projects. It draws on quantitative data of multiple project use, and through in-depth qualitative interviews with individuals who have used more than one project. The research found that for some people, likely to be the more isolated or less connected people, accessing the first project can be key. Once people access a project, they are opened up to both informal networks of other people participating in the group and also the more formal networks of project leads, Community Navigators or volunteers. Both groups are able to introduce them to new projects, services and organisations. The report identifies what can facilitate this process by enabling older people to: hear about a project; go to a project; stay at a project; and move to another project.

Engaging with the arts to improve health and wellbeing in social care settings

WELSH NHS CONFEDERATION
2020

This briefing, prepared for the Cross-Party Group on Arts and Health, provides innovative examples of arts-based activities which are being delivered in social care settings across Wales to improve people’s physical and mental wellbeing. They include Live Music Now which supports professional musicians to deliver evidence-based music workshops in care homes; cARTrefu, a project from Age Cymru to improve access to quality arts experiences for older people in residential care homes project; and Bangor University's Dementia and Imagination.

Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities

ABEL Julian, et al
2018

Background: Reducing emergency admissions to hospital has been a cornerstone of healthcare policy. Little evidence exists to show that systematic interventions across a population have achieved this aim. The authors report the impact of a complex intervention over a 44-month period in Frome, Somerset, on unplanned admissions to hospital. Aim: To evaluate a population health complex intervention of an enhanced model of primary care and compassionate communities on population health improvement and reduction of emergency admissions to hospital. Design and setting: A cohort retrospective study of a complex intervention on all emergency admissions in Frome Medical Practice, Somerset, compared with the remainder of Somerset, from April 2013 to December 2017. Method: Patients were identified using broad criteria, including anyone giving cause for concern. Patient-centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% confidence interval [CI] = 2.8 to 13.1, P = 0.006), in unplanned hospital admissions across the whole population of Frome during the study period from April 2013 to December 2017, a decrease of 14.0%. At the same time, there was a 28.5% increase in admissions per quarter within Somerset, with a rise in the number of unplanned admissions of 236 per quarter (95% CI = 152 to 320, P<0.001). Conclusion The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital, with a decrease in healthcare costs across the whole population of Frome.

Results 21 - 30 of 664

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