Ignite Creation Date:
2024-05-06 @ 7:34 PM
Last Modification Date:
2024-10-26 @ 3:09 PM
Study NCT ID:
NCT06064227
Status:
COMPLETED
Last Update Posted:
2023-10-03
First Post:
2023-09-16
Brief Title:
The Effect of Health Promotion Comprehensive Education Intervention on the Frailty Levels of Elderly Family Caregivers
Sponsor:
Fatma Banu Demirdas
Organization:
Akdeniz University
Study Overview
Official Title:
The Effect of Health Promotion Comprehensive Education Intervention on the Frailty Levels of Elderly Family Caregivers
Status:
COMPLETED
Status Verified Date:
2023-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This study was conducted to evaluate the effect of a comprehensive health promotion educational intervention applied to family caregivers over the age of 60 on their fragility levels The main questions it aims to answer are
Does the educational intervention have a significant impact on caregivers vulnerability
Does the educational intervention have a significant impact on caregivers quality of life The population of the study consists of family members who care for individuals receiving home health services in public hospitals in Antalya city center G power test was used to determine the number of samples and the result of the analysis on the subject Alpha value of 001 for independent sample t test at 95 confidence level Taking an effect size of 135 and theoretical power of 99 the minimum total sample size was determined as 58 people 29 for each group It was thought that it would be appropriate to take 30 more than the calculated minimum sample number due to possible losses that may occur during the research process and as a result it was decided to recruit 40 people for each group In the study the Participant Information Form developed by the researcher the Health Promoting Lifestyle Profile HPLP scale the frailty FRAIL scale and the World Health Organization quality of life scale for elderly individuals will be applied to family caregivers SPSS statistical software package will be used in the analysis of the data obtained
Does the educational intervention have a significant impact on caregivers vulnerability
Does the educational intervention have a significant impact on caregivers quality of life The population of the study consists of family members who care for individuals receiving home health services in public hospitals in Antalya city center G power test was used to determine the number of samples and the result of the analysis on the subject Alpha value of 001 for independent sample t test at 95 confidence level Taking an effect size of 135 and theoretical power of 99 the minimum total sample size was determined as 58 people 29 for each group It was thought that it would be appropriate to take 30 more than the calculated minimum sample number due to possible losses that may occur during the research process and as a result it was decided to recruit 40 people for each group In the study the Participant Information Form developed by the researcher the Health Promoting Lifestyle Profile HPLP scale the frailty FRAIL scale and the World Health Organization quality of life scale for elderly individuals will be applied to family caregivers SPSS statistical software package will be used in the analysis of the data obtained
Detailed Description:
While the decline in fertility rates all over the world has led to a demographic transformation improved living conditions and technological advances have contributed to the prolongation of human life span and the increase in the number of elderly individuals In parallel with the increase in the number of elderly people in the total population the need for care is also increasing with long-term chronic diseases that require high-cost complex technological intervention and care Individuals in need of care and family caregivers prefer home care instead of institutional care for both cultural reasons and because the individual feels more autonomous at home Therefore the number of family members providing care at home is increasing
Caring for family members is a stressful and time-consuming process and family caregivers are the primary caregivers of older adults The challenges and burden of care vary depending on the circumstances and are also related to the caregivers adaptation to the care process The resulting maladjustment can lead to inadequate rest interrupted sleep chronic fatigue economic hardship and depression preventing the individual from meeting their own needs Particularly if the care recipient has a cognitive impairment the attention and time required to manage the individuals memory and behavioral issues may leave the caregiver with little time to attend to their own health needs and may neglect or delay their own care In addition family caregivers themselves are often elderly chronically ill and at high risk of illness in part due to lifestyle habits shared with the patient All this can put caregivers at risk for emotional and physical problems and increase the susceptibility of older caregivers to health problems and frailty a geriatric syndrome Therefore awareness of the risks associated with frailty early identification and appropriate interventions can contribute to protecting and maintaining the health of this group
The World Health Organization WHO has conceptually defined frailty as a clinically recognizable condition in which older people have an increased ability to cope with daily or acute stressors due to age-related declines in physiological reserves and the functioning of multiple organ systems Depending on the decrease in homeostatic reserves the frailty process can be considered in three stages from non-frail to frail These can be leveled as pre-frailty frailty and the process of experiencing complications of frailty Pre-frailty or fragility is clinically silent and most amenable to correction through interventions Frailty on the other hand is a process in which available reserves are rapidly depleted leading to rapid functional deterioration from well-being The process of frailty complications can be described as an irreversible vicious circle leading to death Although frailty has been misinterpreted in some studies as a pre-disease state that defines the end of life the first epidemiologic data on transitions between frailty stages were reported by Gill et al 2006 Based on a 45-year longitudinal study of 754 older adults aged 70 years and older In a 5-year longitudinal study of 754 older adults aged 70 years and older it was found that 58 of participants made at least one transition between any two of the three frailty states at three follow-up visits 18 months apart and that this transition occurred in about one-third of all visits with participants moving from more advanced frailty states to less frailty states This suggests that although advancing age increases the risk of frailty in individuals frailty is not an inevitable consequence of ageing nor is frailty an irreversible process or an inevitable path to death
Although there is no gold standard for detecting frailty multiple frailty screening tools have been developed and used for risk assessment and epidemiologic study Therefore the results of studies on the prevalence of frailty vary according to the age range population scale and measurement criteria used In Europe Eggiman et al 2009 measured the prevalence of frailty in the same age group within the SHARE project and found the prevalence of frailty to be 170 and the pre-frailty rate to be 423 Based on the studies in the literature frailty risk factors can be categorized under four main headings socio-demographic factors lifestyle factors medical risk factors and biological factors
Socio-demographic factors include age gender ethnicity education low socio-economic status living alone and loneliness while medical risk factors include chronic diseases multimorbidity obesity malnutrition weight loss impaired cognition depressive symptoms and polypharmacy Lifestyle-related risk factors include physical inactivity diet smoking and alcohol use Biological risk factors include immune and neuroendocrine dysregulation sarcopenia and energy imbalancesoxidative stress For many individuals the negative effects of these risk factors can be slowed down stopped or even rapidly reversed with evidence-based early interventions for lifestyle and medical risk factors Especially the avoidance of risky behaviors and healthy lifestyle behaviors that the individual performs with the support and awareness heshe receives have a significant contribution to the prevention of diseases and promotion of health In the literature there are many evidence-based studies on smoking healthy eating physical activity and immunization
The onset of frailty in older people is thought to precede the behavioral adaptation that occurs in response to a reduced physiological reserve and capacity to meet environmental challenges Xue 2011 suggested that the frailty process can be initiated through any of the clinically visible symptoms which can then accelerate a vicious cycle resulting in a collective syndrome and that different initial symptoms can lead to different rates of progression towards frailty Recognizing and observing behavioral changes at an early stage in these older individuals where frailty is developing but not yet detected may be a way to intervene early in the frailty development process Therefore the development and evaluation of interventions designed to prevent or ameliorate frailty should be a top priority in frailty research Penders Health Promotion Model HPM is one of the most widely used models to identify and change unhealthy behaviors and improve health This model was developed by Pender in 1987 and revised in 1996 The model guides practices in the field of health promotion and is derived from expectancy-value theory and social cognitive theory which emphasize the importance of cognitively mediated processes in behavior choice and regulation of behavior The Expectancy-Value Theory is based on the idea that individuals will act willingly to achieve goals whose outcomes they value and the Social Cognitive Theory is based on the idea that individuals thoughts direct their behaviors and that thoughts behaviors and the environment affect each other
The last version of the HPM updated in 1996 consists of three main components
1 Individual characteristics and experiences These are biological psychological and sociocultural factors including characteristics such as age gender education income occupation status personal abilities and experiences that have a direct or indirect effect on behavior
2 Behavior-specific cognitive-perceptual factors These are the primary motivational factors for the acquisition and maintenance of health-promoting behaviors and include perceived benefitsbarriers to behaviors perceived self-efficacy perceived health status mood related to the behavior interpersonal effects and environmental-situational effects
Pender assumes that perceived benefits and barriers directly affect engaging in health-promoting behaviors Studies in the literature on the subject have revealed that older adults participation in health promotion activities is closely related to perceived activity benefits and barriers In terms of perceived benefits older adults participation in health promotion activities was found to improve their physical and psychological health while perceived barriers were found to negatively affect their motivation in health promotion activities The most commonly experienced barriers that prevent participation in behavior-specific health promotion activities by older adults can be defined as access barriers lack of information difficulty level of the health-promoting behavior lack of social support financial difficulties fear of injury and uncomfortable symptoms Perceived Health Status as a self-assessment of participants perceived current overall health is an important aspect of older adults lives and can influence beliefs about outcomes and competencies for health-promoting behaviors The choices an individual makes about engaging in a particular health behavior are influenced by their expectations about the outcome and beliefs about their efficacy When an individual believes that he or she has little or no control over the outcome of a particular situation this may prevent him or her from taking action In Penders Health Promotion Model the concept of perceived self-efficacy is included as a part of cognitive and emotional factors specific to behavior In the literature there are many studies reporting that perceived self-efficacy is an important factor supporting an individuals participation in health promotion behaviors and lifestyle
3 Behavior Output This component includes making a plan for behavior making a choice among urgent competing wants and preferences and engaging in health behavior
In this study it is aimed that the educational intervention the effect of which is to be measured will directly or indirectly affect the Behavior Specific Cognitive-Perceptual Factors component defined in Penders health model and a positive behavioral outcome will be obtained
Gerontologists have an important position in helping caregivers accept adapt and cope with new situations related to caregiving while at the same time encouraging caregivers to meet their own health needs Home caregivers need simple practical affordable information and advice on nutrition chronic disease management medication exercise access to health care and preventive services and stress management Providing these and achieving evidence-based lifestyle practices diet and physical activity will be an important step towards preventing frailty in this population
Caring for family members is a stressful and time-consuming process and family caregivers are the primary caregivers of older adults The challenges and burden of care vary depending on the circumstances and are also related to the caregivers adaptation to the care process The resulting maladjustment can lead to inadequate rest interrupted sleep chronic fatigue economic hardship and depression preventing the individual from meeting their own needs Particularly if the care recipient has a cognitive impairment the attention and time required to manage the individuals memory and behavioral issues may leave the caregiver with little time to attend to their own health needs and may neglect or delay their own care In addition family caregivers themselves are often elderly chronically ill and at high risk of illness in part due to lifestyle habits shared with the patient All this can put caregivers at risk for emotional and physical problems and increase the susceptibility of older caregivers to health problems and frailty a geriatric syndrome Therefore awareness of the risks associated with frailty early identification and appropriate interventions can contribute to protecting and maintaining the health of this group
The World Health Organization WHO has conceptually defined frailty as a clinically recognizable condition in which older people have an increased ability to cope with daily or acute stressors due to age-related declines in physiological reserves and the functioning of multiple organ systems Depending on the decrease in homeostatic reserves the frailty process can be considered in three stages from non-frail to frail These can be leveled as pre-frailty frailty and the process of experiencing complications of frailty Pre-frailty or fragility is clinically silent and most amenable to correction through interventions Frailty on the other hand is a process in which available reserves are rapidly depleted leading to rapid functional deterioration from well-being The process of frailty complications can be described as an irreversible vicious circle leading to death Although frailty has been misinterpreted in some studies as a pre-disease state that defines the end of life the first epidemiologic data on transitions between frailty stages were reported by Gill et al 2006 Based on a 45-year longitudinal study of 754 older adults aged 70 years and older In a 5-year longitudinal study of 754 older adults aged 70 years and older it was found that 58 of participants made at least one transition between any two of the three frailty states at three follow-up visits 18 months apart and that this transition occurred in about one-third of all visits with participants moving from more advanced frailty states to less frailty states This suggests that although advancing age increases the risk of frailty in individuals frailty is not an inevitable consequence of ageing nor is frailty an irreversible process or an inevitable path to death
Although there is no gold standard for detecting frailty multiple frailty screening tools have been developed and used for risk assessment and epidemiologic study Therefore the results of studies on the prevalence of frailty vary according to the age range population scale and measurement criteria used In Europe Eggiman et al 2009 measured the prevalence of frailty in the same age group within the SHARE project and found the prevalence of frailty to be 170 and the pre-frailty rate to be 423 Based on the studies in the literature frailty risk factors can be categorized under four main headings socio-demographic factors lifestyle factors medical risk factors and biological factors
Socio-demographic factors include age gender ethnicity education low socio-economic status living alone and loneliness while medical risk factors include chronic diseases multimorbidity obesity malnutrition weight loss impaired cognition depressive symptoms and polypharmacy Lifestyle-related risk factors include physical inactivity diet smoking and alcohol use Biological risk factors include immune and neuroendocrine dysregulation sarcopenia and energy imbalancesoxidative stress For many individuals the negative effects of these risk factors can be slowed down stopped or even rapidly reversed with evidence-based early interventions for lifestyle and medical risk factors Especially the avoidance of risky behaviors and healthy lifestyle behaviors that the individual performs with the support and awareness heshe receives have a significant contribution to the prevention of diseases and promotion of health In the literature there are many evidence-based studies on smoking healthy eating physical activity and immunization
The onset of frailty in older people is thought to precede the behavioral adaptation that occurs in response to a reduced physiological reserve and capacity to meet environmental challenges Xue 2011 suggested that the frailty process can be initiated through any of the clinically visible symptoms which can then accelerate a vicious cycle resulting in a collective syndrome and that different initial symptoms can lead to different rates of progression towards frailty Recognizing and observing behavioral changes at an early stage in these older individuals where frailty is developing but not yet detected may be a way to intervene early in the frailty development process Therefore the development and evaluation of interventions designed to prevent or ameliorate frailty should be a top priority in frailty research Penders Health Promotion Model HPM is one of the most widely used models to identify and change unhealthy behaviors and improve health This model was developed by Pender in 1987 and revised in 1996 The model guides practices in the field of health promotion and is derived from expectancy-value theory and social cognitive theory which emphasize the importance of cognitively mediated processes in behavior choice and regulation of behavior The Expectancy-Value Theory is based on the idea that individuals will act willingly to achieve goals whose outcomes they value and the Social Cognitive Theory is based on the idea that individuals thoughts direct their behaviors and that thoughts behaviors and the environment affect each other
The last version of the HPM updated in 1996 consists of three main components
1 Individual characteristics and experiences These are biological psychological and sociocultural factors including characteristics such as age gender education income occupation status personal abilities and experiences that have a direct or indirect effect on behavior
2 Behavior-specific cognitive-perceptual factors These are the primary motivational factors for the acquisition and maintenance of health-promoting behaviors and include perceived benefitsbarriers to behaviors perceived self-efficacy perceived health status mood related to the behavior interpersonal effects and environmental-situational effects
Pender assumes that perceived benefits and barriers directly affect engaging in health-promoting behaviors Studies in the literature on the subject have revealed that older adults participation in health promotion activities is closely related to perceived activity benefits and barriers In terms of perceived benefits older adults participation in health promotion activities was found to improve their physical and psychological health while perceived barriers were found to negatively affect their motivation in health promotion activities The most commonly experienced barriers that prevent participation in behavior-specific health promotion activities by older adults can be defined as access barriers lack of information difficulty level of the health-promoting behavior lack of social support financial difficulties fear of injury and uncomfortable symptoms Perceived Health Status as a self-assessment of participants perceived current overall health is an important aspect of older adults lives and can influence beliefs about outcomes and competencies for health-promoting behaviors The choices an individual makes about engaging in a particular health behavior are influenced by their expectations about the outcome and beliefs about their efficacy When an individual believes that he or she has little or no control over the outcome of a particular situation this may prevent him or her from taking action In Penders Health Promotion Model the concept of perceived self-efficacy is included as a part of cognitive and emotional factors specific to behavior In the literature there are many studies reporting that perceived self-efficacy is an important factor supporting an individuals participation in health promotion behaviors and lifestyle
3 Behavior Output This component includes making a plan for behavior making a choice among urgent competing wants and preferences and engaging in health behavior
In this study it is aimed that the educational intervention the effect of which is to be measured will directly or indirectly affect the Behavior Specific Cognitive-Perceptual Factors component defined in Penders health model and a positive behavioral outcome will be obtained
Gerontologists have an important position in helping caregivers accept adapt and cope with new situations related to caregiving while at the same time encouraging caregivers to meet their own health needs Home caregivers need simple practical affordable information and advice on nutrition chronic disease management medication exercise access to health care and preventive services and stress management Providing these and achieving evidence-based lifestyle practices diet and physical activity will be an important step towards preventing frailty in this population
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None