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202. Vitamin D supplementation as a potential cause of U-shaped associations between vitamin D levels and negative health outcomes: a decision tree analysis for risk of frailty

Author

Kojima, Gotaro, Iliffe, Steve, and Tanabe, Marianne

Subjects
Aged, 80 and over, Male, Vitamin D supplementation, Vitamin D deficiency, Frailty, Nursing home, Frail Elderly, Decision Trees, Veterans Health, Middle Aged, lcsh:Geriatrics, Nursing Homes, lcsh:RC952-954.6, Cross-Sectional Studies, Dietary Supplements, Homes for the Aged, Humans, Regression Analysis, Vitamin D, Research Article, Aged, Veterans
Abstract

Background A recent controversy in vitamin D research is a “U-shaped association”, with elevated disease risks at both high and low 25-hydroxyvitamin D (25 (OH) D) levels. Methods This is a cross-sectional study of 238 male nursing home veterans in Hawaii. Classification and regression tree (CART) analysis identified groups based on 25 (OH) D and vitamin D supplementation for frailty risk. Characteristics were examined and compared across the groups using logistic regression and receiver operating characteristic (ROC) curve analyses. Results CART analysis identified three distinct groups: vitamin D supplement users (n = 86), non-users with low vitamin D (n = 55), and non-users with high vitamin D (n = 97). Supplement users were the most frail, but had high mean 25 (OH) D of 26.6 ng/mL, which was compatible with 27.1 ng/mL in non-users with high vitamin D, while mean 25 (OH) D of non-users with low vitamin D was 11.7 ng/mL. Supplement users and non-users with low vitamin D were significantly more likely to be frail (odds ratio (OR) = 9.90, 95% CI = 2.18–44.86, p = 0.003; OR = 4.28, 95% CI = 1.44–12.68, p = 0.009, respectively), compared with non-users with low vitamin D. ROC curve analysis showed the three groups significantly predicted frailty (area under the curve = 0.73), with sensitivity of 64.4% and specificity of 76.7%, while 25 (OH) D did not predict frailty. Conclusions In these nursing home veterans, vitamin D supplement users were the most frail but with high 25 (OH) D. This can potentially be a cause of U-shaped associations between vitamin D levels and negative health outcomes. Electronic supplementary material The online version of this article (doi: 10.1186/s12877-017-0631-0) contains supplementary material, which is available to authorized users.

Published
2017
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203. Strategies to improve engagement of ‘hard to reach’ older people in research on health promotion: a systematic review

Author

Liljas, Ann E. M., Walters, Kate, Jovicic, Ana, Iliffe, Steve, Manthorpe, Jill, Goodman, Claire, and Kharicha, Kalpa

Subjects
Deprivation, Cultural Characteristics, Patient Selection, lcsh:Public aspects of medicine, Age Factors, Social Support, lcsh:RA1-1270, Trust, House Calls, Oldest old, Ageing, Ethnicity, Humans, Health promotion, Health Services Research, Inequalities, Older people, Research Article, Aged
Abstract

Background: This systematic review aimed to identify facilitators, barriers and strategies for engaging ‘hard to reach’ older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas. Methods: Eight databases were searched to identify eligible studies using quantitative, qualitative, and mixed research methods. Using elements of narrative synthesis, engagement strategies, and reported facilitators and barriers were identified, tabulated and analysed thematically for each of the three groups of older people. Results: Twenty-three studies (3 with oldest-old, 16 with BME older people, 2 within deprived areas, 1 with both oldest-old and BME, 1 with both BME and deprived areas) were included. Methods included 10 quantitative studies (of which 1 was an RCT), 12 qualitative studies and one mixed-methods study. Facilitators for engaging the oldest old included gaining family support and having flexible sessions. Facilitators for BME groups included building trust through known professionals/community leaders, targeting personal interests, and addressing ethnic and cultural characteristics. Among older people in deprived areas, facilitators for engagement included encouragement by peers and providing refreshments. Across all groups, barriers for engagement were deteriorating health, having other priorities and lack of transport/inaccessibility. Feeling too tired and lacking support from family members were additional barriers for the oldest old. Similarly, feeling too tired and too old to participate in research on health promotion were reported by BME groups. Barriers for BME groups included lack of motivation and self-confidence, and cultural and language differences. Barriers identified in deprived areas included use of written recruitment materials. Strategies to successfully engage with the oldest old included home visits and professionals securing consent if needed. Strategies to engage older people from BME groups included developing community connections and organising social group sessions. Strategies to engage with older people in deprived areas included flexibility in timing and location of interventions. Conclusions: This review identified facilitators, barriers and strategies for engaging ‘hard to reach’ older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches.

Published
2017
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210. Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial

Author

Harris, Tess, Kerry, Sally M., Limb, Elizabeth S., Victor, Christina R., Iliffe, Steve, Ussher, Michael, Whincup, Peter H., Ekelund, Ulf, Fox-Rushby, Julia, Furness, Cheryl, Anokye, Nana, Ibison, Judith, DeWilde, Steve, David, Lee, Howard, Emma, Dale, Rebecca, Smith, Jaime, and Cook, Derek G.

Subjects
Pedometers -- Usage, Physically disabled persons -- Physiological aspects, Primary health care -- Methods, Biological sciences
Abstract

Background Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations. Methods and Findings A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45-75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012-2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in [greater than or equal to]10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329-955) and 677 for nurse support (95% CI 365-989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17-49) and 35 for nurse support (95% CI 19-51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation. Conclusions A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge. Clinical Trial Registration isrctn.com ISRCTN98538934., Author(s): Tess Harris 1,*, Sally M. Kerry 2, Elizabeth S. Limb 1, Christina R. Victor 3, Steve Iliffe 4, Michael Ussher 1, Peter H. Whincup 1, Ulf Ekelund 5,6, Julia [...]

Published
2017
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212. 'It is designed for everybody to find their own level and to improve themselves'; views of older people and instructors of the Falls Management Exercise (FaME) programme.

Author

Gumber, Leher, Timmons, Stephen, Coupland, Carol, Gladman, Johnrf, Iliffe, Steve, Kendrick, Denise, Lafond, Natasher, Logan, Pip, Masud, Tahir, Skelton, Dawna, and Orton, Elizabeth

Subjects
WELL-being, AFFINITY groups, PATIENT participation, ATTITUDES of medical personnel, RESEARCH methodology, COMMUNITY health services, INTERVIEWING, PATIENTS' attitudes, RESPONSIBILITY, ACCIDENTAL falls, INTERPERSONAL relations, THEMATIC analysis, PATIENT compliance, SOCIAL skills, DISCIPLINE of children, OLD age
Abstract

Background Older adults are at increased risk of falls due to ageing, decreased muscle strength and impaired balance. Clinical trials have demonstrated the efficacy and effectiveness of the Falls Management Exercise (FaME) programme in improving functioning and preventing falls. However, programme completion is often low, impacting the potential benefits of FaME. Objective To explore the barriers and facilitators for participation and completion of the FaME programme from an instructor and participant perspective. Methods Semi-structured interviews were conducted with 20 FaME users and seven Postural Stability Instructors from the East Midlands region of England, UK. Interviews were conducted using a topic guide and explored their views of the programme, intended benefits, reasons for participating, instructor's approach and venue facilities. Data were transcribed verbatim and analysed using thematic analysis. Written informed consent was obtained from all participants and instructors. Results Common themes identified by participants and instructors for adherence related to perceived health benefits, psychological well-being, intervention characteristics, cost, instructors' qualities, opportunity to socialise, venue accessibility and facilities. Further factors such as maintaining independence, discipline, relationship with peers and caring responsibilities influenced participants' engagement with the programme. Instructor factors such as progression were also reported as important predictors. Conclusions Instructor and participant factors influence uptake, attendance and adherence of FaME. The findings from this study can inform the development and improvement of additional falls-prevention programmes. It can also guide marketing strategies to promote uptake of exercise-based falls-prevention programmes among older adults. [ABSTRACT FROM AUTHOR]

Published
2022
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