Informing an assistive living technology intervention to prevent hospitalisations for home-dwelling older persons

What are the key contextual factors when preparing for successful implementation of assistive living technology in primary elderly care? A case study from Norway

BMJ Open ◽

10.1136/bmjopen-2016-015455 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015455 ◽

Cited By ~ 10

Author(s):

Martha Therese Gjestsen ◽

Siri Wiig ◽

Ingelin Testad

Keyword(s):

Contextual Factors ◽

Healthcare Personnel ◽

Focus Group Interviews ◽

Policy Documents ◽

Individual Interviews ◽

Technology Intervention ◽

Micro Level ◽

Assistive Living ◽

Group Interviews

ObjectiveTo identify contextual factors at different organisational levels to guide the implementation of an assistive living technology intervention in Norwegian primary home care.DesignA single embedded case study design was carried out in an urban municipality in Western Norway to get an overview of key contextual factors from the municipality’s perspective.Data collection and analysisThe data collection was based on a triangulation of methods involving document analysis, semi-structured individual interviews and focus group interviews to get a broad insight when preparing for an intervention. Data were collected on three levels of the healthcare system: (1) national policy documents and regulations (macro), (2) five individual interviews with senior managers and municipal strategy documents (meso) and (3) two focus group interviews with nurses and nurse managers in direct patient care (micro). The Model for Understanding Success in Quality framework was used as a guide in the data analysis.ResultsThe main contextual factors identified were external motivators and project sponsorship (macro level); leadership, workforce focus and maturity (meso level);and motivation to change and maturity (micro level). Strategies developed in policy documents affected upper management in the municipality, but healthcare personnel at the micro level were not so familiar with strategies and emphasis on assistive living technologies. Healthcare personnel in our study were motivated to use technological solutions, but lack of data infrastructure and resource availability hindered this.ConclusionsAligning interests across multiple stakeholders remain a challenge when planning for an assistive living technology intervention in primary care. In the studied municipality, integration of technological solutions into healthcare services was more a vision than a reality because of a low level of organisational readiness.

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Effects of a Group Program to Increase Cognitive Performance Through Cognitively Stimulating Leisure Activities in Healthy Older Subjects

GeroPsych ◽

10.1024/1662-9647/a000035 ◽

2011 ◽

Vol 24 (2) ◽

pp. 83-92 ◽

Cited By ~ 22

Author(s):

Valentina A. Tesky ◽

Christian Thiel ◽

Winfried Banzer ◽

Johannes Pantel

Keyword(s):

Cognitive Function ◽

Cognitive Performance ◽

Older Persons ◽

Intervention Program ◽

Leisure Activities ◽

The Elderly ◽

Cognitive Stimulation ◽

Group Program ◽

Positive Effects ◽

Older Subjects

To investigate the effects of leisure activities on cognitive performance of healthy older subjects, an innovative intervention program was developed. Frequent participation in cognitively stimulating activities (i.e., reading, playing chess, or playing music) is associated with reduced risk of dementia. AKTIVA (active cognitive stimulation – prevention in the elderly) is an intervention program designed to enhance cognitive stimulation in everyday life by increasing cognitive stimulating leisure activities. The present study determines the effects of AKTIVA on cognitive function, mood and attitude toward aging in a sample of older participants from the general population. Several measurement instruments were used including the Alzheimer’s Disease Assessment Scale (ADAS-Cog), the Trail-Making Test (TMT), and the Memory Complaint Questionnaire (MAC-Q). Initially, the sample consisted of 307 older persons (170 female, 72 ± 7 years). The intervention was evaluated with a randomized, controlled pre-post follow-up design. Participants were randomly assigned to one of three conditions: AKTIVA intervention (n = 126), AKTIVA intervention plus nutrition and exercise counseling (n = 84), no-intervention control group (n = 97). The AKTIVA intervention consisted of 8 weekly sessions and two booster sessions after a break of 4 months. Participation in the group program resulted in positive effects on cognitive function and attitude toward aging for subassembly groups. Older persons (≥ 75 years) showed enhanced speed of information processing (by TMT Version A) (F = 4.17*, p < .05); younger participants (< 75 years) showed an improvement in subjective memory decline (by MAC-Q) (F = 2.55*, p < .05). Additionally, AKTIVA enhanced the frequency of activities for leisure activities for subassembly groups. The results of this study suggest that the AKTIVA program can be used to increase cognitively stimulating leisure activities in the elderly. Further research is necessary to identify the long-term effects of this intervention particularly with respect to the prevention of dementia.

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The Case of Thematic Tests Adapted to Older Adults

Rorschachiana Journal of the International Society for the Rorschach ◽

10.1027/1192-5604/a000015 ◽

2011 ◽

Vol 32 (1) ◽

pp. 46-71 ◽

Cited By ~ 6

Author(s):

Benoît Verdon

Keyword(s):

Older Adults ◽

Older Persons ◽

Older Men ◽

Elderly Persons ◽

Mental Processes ◽

Men And Women ◽

Projective Tests ◽

New Material ◽

Older Men And Women ◽

Latent Content

Since the 1950s, the growing interest of clinicians in using projective tests to study normal or pathological aging processes has led to the creation of several thematic tests for older adults. This development reflects their authors’ belief that the TAT is not suitable to the concerns and anxieties of elderly persons. The new material thus refers explicitly to situations related to age; it aims to enable older persons to express needs they cannot verbalize during consultations. The psychodynamic approach to thematic testing is based on the differentiation between the pictures’ manifest and latent content, eliciting responses linked to mental processes and issues the respondent is unaware of. The cards do not necessarily have to show aging characters to elicit identification: The situations shown in the pictures are linked to loss, rivalry, helplessness, and renunciation, all issues elderly respondents can identify with and that lead them to express their mental fragilities and resources. The article first explains the principles underlying four of these thematic tests, then develops several examples of stories told for card 3BM of the TAT, thus showing the effectiveness of this tool for the understanding and differentiation of loss-related issues facing older men and women.

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