Research article

Promoting aging migrants’ capabilities: A randomized controlled trial concerning activities of daily living and self-rated health

  • Received: 14 March 2018 Accepted: 29 May 2018 Published: 12 June 2018
  • The aim was to evaluate the 6-month and 1-year effects of a person-centered group-based health-promoting intervention on independence in daily activities and self-rated health. The study was an RCT with follow-ups at 6 months and 1 year. A total of 131 independent living people (70+) who have migrated to Sweden from Finland or Western Balkan region were included. Participants were independent in activities of daily living and cognitively intact. They were randomized to an intervention group receiving four weekly group-meetings and a follow-up home visit, or a control group (no intervention). An overall chi-squared test was performed and the odds ratio calculated. A high proportion of the participants maintained independence in activities of daily living and improved or maintained self-rated health. However, no significant differences were found between the groups. The result indicates that the intervention was offered too early in the aging process to be able to detect effects. Methodological challenges were met during both the recruitment and implementation phases. In response to lessons learned, a multicenter design is recommended for future research in order to strengthen the findings. Furthermore, this study has contributed with experiences on both opportunities and challenges in terms of research with and about older people aging in the context of migration, as is discussed.

    Citation: Emmelie Barenfeld, Synneve Dahlin-Ivanoff, Lars Wallin, Susanne Gustafsson. Promoting aging migrants’ capabilities: A randomized controlled trial concerning activities of daily living and self-rated health[J]. AIMS Public Health, 2018, 5(2): 173-188. doi: 10.3934/publichealth.2018.2.173

    Related Papers:

  • The aim was to evaluate the 6-month and 1-year effects of a person-centered group-based health-promoting intervention on independence in daily activities and self-rated health. The study was an RCT with follow-ups at 6 months and 1 year. A total of 131 independent living people (70+) who have migrated to Sweden from Finland or Western Balkan region were included. Participants were independent in activities of daily living and cognitively intact. They were randomized to an intervention group receiving four weekly group-meetings and a follow-up home visit, or a control group (no intervention). An overall chi-squared test was performed and the odds ratio calculated. A high proportion of the participants maintained independence in activities of daily living and improved or maintained self-rated health. However, no significant differences were found between the groups. The result indicates that the intervention was offered too early in the aging process to be able to detect effects. Methodological challenges were met during both the recruitment and implementation phases. In response to lessons learned, a multicenter design is recommended for future research in order to strengthen the findings. Furthermore, this study has contributed with experiences on both opportunities and challenges in terms of research with and about older people aging in the context of migration, as is discussed.


    加载中
    [1] Rechel B, Mladovsky P, Ingleby D, et al. (2013) Migration and health in an increasingly diverse Europe. Lancet 381: 1235–1245. doi: 10.1016/S0140-6736(12)62086-8
    [2] Sen AK (1993) Capability and well-being. Qual Life 1993: 30–54.
    [3] World Health Organization (1986) Ottawa Charter for Health Promotion.
    [4] Nordenfeldt L (2006) The concept of health and illness revisited. Med Health Philos 10: 5–10.
    [5] Haak M, Fänge A, Iwarsson S, et al. (2007) Home as a signification of independence and autonomy: Experiences among very old Swedish people. Scand J Occup Ther 14: 16–24. doi: 10.1080/11038120601024929
    [6] Sixsmith J, Sixsmith A, Fänge A, et al. (2014) Healthy ageing and home: The perspectives of very old people in five European countries. Social Sci Med 106: 1–9. doi: 10.1016/j.socscimed.2014.01.006
    [7] Wilcock AA (2007) Occupation and health: Are they one and the same? J Occup Sci 14: 3–8. doi: 10.1080/14427591.2007.9686577
    [8] Christiansen CH, (2001) Self care, In: Bonder BR, Wagner M, editors., Functional performance in older adults, Philadelphia: F. A. Davis, 155–175.
    [9] Beswick AD, Rees K, Dieppe P, et al. (2008) Complex interventions to improve physical function and maintain independent living in elderly people: A systematic review and meta-analysis. Lancet 371: 725–735. doi: 10.1016/S0140-6736(08)60342-6
    [10] Huss A, Stuck AE, Rubenstein LZ, et al. (2008) Multidimensional preventive home visit programs for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials. J Gerontol 63: 298–307. doi: 10.1093/gerona/63.3.298
    [11] Gustafsson S, Eklund K, Wilhelmson K, et al. (2012) Long-Term Outcome for ADL Following the Health-Promoting RCT-Elderly Persons in the Risk Zone. Gerontologist 53: 654–663.
    [12] Stuck AE, Minder CE, Peter-Wuest I (2000) A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Arch Intern Med 160: 977. doi: 10.1001/archinte.160.7.977
    [13] Brothers TD, Theou O, Rockwood K (2014) Frailty and migration in middle-aged and older Europeans. Arch Gerontol Geriatr 58: 63–68. doi: 10.1016/j.archger.2013.07.008
    [14] Morley JE, Evans J, Fried LP, et al. (2013) Frailty consensus: A call to action. J Am Med Dir Assoc 14: 392–397. doi: 10.1016/j.jamda.2013.03.022
    [15] Alizadeh-Khoei M, Mathews RM, Hossain SZ (2011) The role of acculturation in health status and utilization of health services among the Iranian elderly in Metropolitan Sydney. J Cross Cult Gerontol 26: 397–405. doi: 10.1007/s10823-011-9152-z
    [16] Bhugra D (2004) Migration, distress and cultural identity. Br Med Bull 69: 129–141. doi: 10.1093/bmb/ldh007
    [17] Kreps GL, Sparks L (2008) Meeting the health literacy needs of immigrant populations. Patient Educ Couns 71: 328–332. doi: 10.1016/j.pec.2008.03.001
    [18] Lood Q, Häggblom-Kronlöf G, Dahlin-Ivanoff S (2015) Health promotion programme design and efficacy in relation to ageing persons with culturally and linguistically diverse backgrounds: A systematic literature review and meta-analysis. BMC Health Serv Res 15: 560. doi: 10.1186/s12913-015-1222-4
    [19] Liu JJ, Davidson E, Bhopal RS, et al. (2012) Adapting health promotion interventions to meet the needs of ethnic minority groups: Mixed-methods evidence synthesis. Health Technol Assess 16: 1–469.
    [20] Clark F, Jackson J, Carlson M, et al. (2012) Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: Results of the Well Elderly 2 Randomised Controlled Trial. J Epidemiol Community Health 66: 782–790. doi: 10.1136/jech.2009.099754
    [21] Clark F, Azen SP, Carlson M, et al. (2001) Embedding health-promoting changes into the daily lives of independent-living older adults: Long-term follow-up of occupational therapy intervention. J Gerontol B Psychol Sci Soc Sci 56: 60–63. doi: 10.1093/geronb/56.1.P60
    [22] Hulter-Åsberg K (1990) ADL-trappan [In Swedish] (ADL-staircase). Lund: Studentlitteratur.
    [23] World Health Organization (2001) ICF: International classification of functioning, disability and health.
    [24] Ocampo JM (2010) Self-rated health: Importance of use in elderly adults. Colomb Médica 41: 275–289.
    [25] Dahlin-Ivanoff S, Gosman-Hedstrom G, Edberg AK, et al. (2010) Elderly persons in the risk zone. Design of a multidimensional, health-promoting, randomised three-armed controlled trial for "prefrail" people of 80+ years living at home. BMC Geriatr 10: 27.
    [26] Gustafsson S, Wilhelmson K, Eklund K, et al. (2012) Health-promoting interventions for persons aged 80 and older are successful in the short term-results from the randomized and three-armed Elderly Persons in the Risk Zone study. J Am Geratr Soc 60: 447–454.
    [27] Gustafsson S, Lood Q, Wilhelmson K, et al. (2015) A person-centred approach to health promotion for persons 70+ who have migrated to Sweden: Promoting aging migrants' capabilities implementation and RCT study protocol. BMC Geriatr 15: 10. doi: 10.1186/s12877-015-0005-4
    [28] Lood Q, Gustafsson S, Dahlin-Ivanoff S (2015) Bridging barriers to health promotion: A feasibility pilot study of the 'Promoting Aging Migrants' Capabilities Study'. J Eval Clin Pract 21: 604–613. doi: 10.1111/jep.12345
    [29] Barenfeld E, Gustafsson S, Wallin L, et al. (2015) Understanding the "black box" of a health-promotion program: Keys to enable health among older persons aging in the context of migration. Int J Qual Stud Health Well-being, 10.
    [30] Barenfeld E, Gustafsson S, Wallin L, et al. (2017) Supporting decision-making by a health promotion programme: Experiences of persons ageing in the context of migration. Int J Qual Stud Health Well-being, 12.
    [31] Zwarenstein M, Treweek S, Gagnier JJ, et al. (2008) Improving the reporting of pragmatic trials: An extension of the CONSORT statement. BMJ Br Med J 337: 2.
    [32] Sadler GR, Lee HC, Lim RSH, et al. (2010) Recruitment of hard-to-reach population subgroups via adaptations of the snowball sampling strategy. Nurs Health Sci 12: 369–374. doi: 10.1111/j.1442-2018.2010.00541.x
    [33] Sonn U (1996) Longitudinal studies of dependence in daily life activities among elderly persons. Scand J Rehabil Med Suppl 34: 1–35.
    [34] Folstein MF, Folstein SE, Mchugh PR (1975) "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198.
    [35] Ekman I, Swedberg K, Taft C, et al. (2011) Person-centered care-ready for prime time. Eur J Cardiovasc Nurs 10: 248–251. doi: 10.1016/j.ejcnurse.2011.06.008
    [36] Leplege A, Gzil F, Cammelli M, et al. (2007) Person-centredness: Conceptual and historical perspectives. Disabil Rehabil 29: 1555–1565. doi: 10.1080/09638280701618661
    [37] Shiner M (1999) Defining peer education. J Adolesc 22: 555–566. doi: 10.1006/jado.1999.0248
    [38] Ware JE, Kosinski M (1993) SF-36 Health survey: Manual and interpretation guide. Boston: The Health Institute, New England Medical Center.
    [39] Berg KO, Wooddauphinee SL, Williams JI (1992) Measuring balance in the elderly: Validation of an instrument. Can J Public Health 83: 7–11.
    [40] Altman D (1991) Practical statistics for medical research. London: Chapman & Hall.
    [41] Unnebrink K, Windeler J (1999) Sensitivity analysis by worst and best case assessment: Is it really sensitive? Ther Innovation Regul Sci 33: 835–839.
    [42] White IR, Carpenter J, Horton NJ (2012) Including all individuals is not enough: Lessons for intention-to-treat analysis. Clin Trials 9: 396–407. doi: 10.1177/1740774512450098
    [43] Hardy SE, Allore H, Studenski SA (2009) Missing data: A special challenge in aging research. J Am Geriatr Soc 57: 722–729. doi: 10.1111/j.1532-5415.2008.02168.x
    [44] Fugl-Meyer AR, Bränholm IB, Fugl-Meyer KS (1991) Happiness and domain-specific life satisfaction in adult northern Swedes. Clin Rehabil 5: 25–33. doi: 10.1177/026921559100500105
    [45] Gustafsson S, Hörder HM, Rydberg T, et al. (2017) A cross-cultural adaptation of the ICECAP-O: Reliability and validity in Swedish 70-year-old persons. Health Psychol Res E-published ahead of print.
    [46] Grewal I, Lewis J, Flynn T, et al. (2006) Developing attributes for a generic quality of life measure for older people: Preferences or capabilities? Soc Sci Med 62: 1891–1901. doi: 10.1016/j.socscimed.2005.08.023
    [47] Silveira E, Skoog I, Sundh V, et al. (2002) Health and well-being among 70-year-old migrants living in Sweden-results from the H 70 gerontological and geriatric population studies in Göteborg. Soc Psychiatry Psychiatr Epidemiol 37: 13–22. doi: 10.1007/s127-002-8209-5
    [48] Pudaric S, Sundquist J, Johansson SE (2003) Country of birth, instrumental activities of daily living, self-rated health and mortality: A Swedish population-based survey of people aged 55–74. Soc Sci Med 56: 2493–2503. doi: 10.1016/S0277-9536(02)00284-8
    [49] Barenfeld E, Wallin L, Björk BE (2017) Moving from knowledge to action in partnership: A case study on program adaptation to support optimal aging in the context of migration. J Appl Gerontol.
    [50] Hussain-Gambles M, Atkin K, Leese B (2004) Why ethnic minority groups are under-represented in clinical trials: A review of the literature. Health Soc Care Comm 12: 382–388. doi: 10.1111/j.1365-2524.2004.00507.x
    [51] Rogers WA (2004) Evidence based medicine and justice: A framework for looking at the impact of EBM upon vulnerable or disadvantaged groups. J Med Ethics 30: 141. doi: 10.1136/jme.2003.007062
    [52] Eklund K, Wilhelmsson K, Landal S, et al. (2016) Screening for frailty among older emergency department visitors: Validation of the new FRESH-screening instrument. BMC Emerg Med 16: 27. doi: 10.1186/s12873-016-0087-0
  • Reader Comments
  • © 2018 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(3394) PDF downloads(817) Cited by(5)

Article outline

Figures and Tables

Figures(1)  /  Tables(5)

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog