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Maintaining Independence in Daily Activities

Options to Maintain Independence of the Older Adult

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  • Physical Activity Tailored to Older Adults
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  • Physical Activity Tailored to Older Adults

    Physical activity programs can be adapted to older adults. They may include walking, water exercises, balance or flexibility exercises, and weight training. They can be done individually at home or with other people. The activities should produce a sensation of warmth, and make you breathe harder. You should be able to hold a conversation while exercising but be too short of breath to sing.

    Benefits of Physical Activity Tailored to Older Adults
    Ability to perform daily activities

    For every 100 older adults who are physically active, 12 improve their ability to perform daily activities due to physical activity.

    • Learn more about the studies
      Studies description
      Ability to perform daily activities is improved for...

      47% of older adults

      35% of older adults

      12% of older adults

      With Without Impact
      Confidence in these results: Low

      Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

      Downgraded because of risk of bias (missing information about random sequence generation, allocation concealment or blinding of participants and assessors in more than 50% of the studies) and heterogeneity of the results 

      Studies and references

      New meta-analysis by the Decision Box team based on the results reported in Gine-Garriga et al. [2014]. Arch Phys Med Rehabil, 95 [4], 753-769;e753.

      Design: Systematic review of 19 randomized controlled trials, including 6 trials on ADL; Participants: 594 individuals aged 65 and older with moderate dependence in terms of mobility; Intervention: Physical activity (e. g., aerobic, balance, flexibility, endurance, strength activities, or other activities related to maintaining and improving performance in ADL); Follow-up: Varied from the end of intervention to 6 months.

    Walking speed

    For every 100 older adults who are physically active, 2 increase their walking speed due to physical activity.

    • Learn more about the studies
      Studies description
      Walking speed is increased for...

      34% of older adults

      32% of older adults

      2% of older adults

      With Without Impact
      Confidence in these results: Low

      Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

      Downgraded because of risk of bias (missing information about random sequence generation, allocation concealment and/or blinding [glossary link] of participants and assessors in more than 50% of the studies)

      Studies and references

      New meta-analysis by the Decision Box team based on the results reported in Gine-Garriga et al. [2014]. Arch Phys Med Rehabil, 95 [4], 753-769;e753.

      Design: Systematic review of 19 randomized controlled trials, including 5 trials on gait speed; Participants: 532 individuals aged 65 and older with moderate dependence in terms of mobility; Intervention: Physical activity (e.g., aerobic, balance, flexibility, endurance, strength activities, or other activities related to maintaining and improving performance in ADL); Follow-up: variable among studies, from the end of intervention to 6 months.

    Endurance

    For every 100 older adults who are physically active, 16 increase their endurance due to physical activity.

    • Learn more about the studies
      Studies description
      Endurance is increased for...

      48% of older adults

      32% of older adults

      16% of older adults

      With Without Impact
      Confidence in these results: Moderate

      Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

      Downgraded because of risk of bias (missing information about random sequence generation, allocation concealment and/or blinding [glossary link] of participants and assessors). 

      Studies and references

      New meta-analysis by the Decision Box team based on the results reported in Gine-Garriga et al. [2014]. Arch Phys Med Rehabil, 95 [4], 753-769;e753.

      Design: Systematic review of 19 randomized controlled trials, including 2 trials on endurance; Participants: 81 individuals aged 65 and older with moderate dependence in terms of mobility; Intervention: Physical activity (e.g., aerobic, balance, flexibility, endurance, strength activities, or other activities related to maintaining and improving performance in ADL; Follow-up: Varied among studies, from the end of intervention to 6 months.

    Balance

    Older adults who are physically active experience inconsistent effects on their balance. Some tests suggest they increase their balance, while others suggest they do not.

    • Learn more about the studies
      Studies description
      Confidence in these results: Very low

      Any estimate of effect is very uncertain.

      Downgraded because of risk of bias (missing information about random sequence generation, allocation concealment and/or blinding [glossary link] of participants and assessors), heterogeneity and imprecision. 

      Studies and references

      Gine-Garriga et al. [2014]. Arch Phys Med Rehabil, 95 (4), 753-769.e753.

      Design: Systematic review of 19 randomized controlled trials, including 13 trials on balance; Participants: 532 older adults with moderate dependence with regard to mobility; Intervention: Physical activity (e.g., aerobic, balance, flexibility, endurance, strength, or other activities related to maintaining and improving performance in ADL); Follow-up: Varied from the end of intervention to 6 months.

    Other health benefits

    Regular physical activity has several additional benefits, for example:

    • reduced risk of chronic disease and premature death
    • independence in daily activities
    • improved fitness and bone health
    • reduced risk of heart diseases
    • improved mood
    • reduced risk of falls
    • improved sleep.
    • Learn more about the studies
      Studies description
      Confidence in these results: High

      Further research is very unlikely to change our confidence in the estimate of effect.

      Data is derived from multiple randomized clinical trials. Evidence supports the notion that physical activity is useful and effective.

      Studies and references

      Nelson et al. [2007]. Med Sci Sports Exerc;39(8):1435-45.

      Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.

    Harms of Physical Activity Tailored to Older Adults
    Muscle, bone, or joint problems

    Some older adults feel temporary muscle soreness after exercising. They can also experience muscle, bone or joint problems (for example  minor strains, tendonitis, exacerbation of osteoarthritis, or joint pain).

    • Learn more about the studies
      Studies description
      Confidence in these results: Very low

      Any estimate of effect is very uncertain.

      Downgraded because of major risk of bias, imprecision, and heterogeneity in the results.

      Studies and references

      El-Khoury et al. [2013]. BMJ 2013, 347:f6234.

      Design: Systematic review of 17 randomised controlled trials; Participants: 4,305 older adults aged 60 years and more living at home; Intervention: Physical activity (e.g., Tai chi, balance or strength exercises) with the aim of preventing falls.

      Liu, C.-j., & Latham, N. K. [2009]. Cochrane Database Syst Rev(3).

      Design: Systematic review of 121 randomised controlled trials; Participants: 6,700 older adults aged 60 years and more; Intervention: Progressive resistance strength training; Follow-up: Varied from the end of the intervention to 1 year.

    Practical issues: Time required

    In general, to experience positive impacts from physical activity, people must be physically active at least 3 weeks, either for 20 minutes 3 times a week, or for 2 hours once a week. Whatever the duration and frequency of the exercise, it takes time.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Gine-Garriga et al. [2014]. Arch Phys Med Rehabil, 95 [4], 753-769;e753.

      Design: Systematic review of 19 randomized controlled trials, including 6 trials on ADL; Participants: 594 individuals aged 65 and older with moderate dependence in terms of mobility; Intervention: Physical activity (e.g., aerobic, balance, flexibility, endurance, strength activities, or other activities related to maintaining and improving performance in ADL); Follow-up: Varied from the end of intervention to 6 months. 

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  • Watchful Waiting

    Watchful waiting consists of actively monitoring the person's health without them undertaking treatment or making lifestyle changes.

    Benefits of Watchful Waiting
    Avoid making a change if the impacts are uncertain

    Among the older adults who make changes improve their independence in daily activities, a certain proportion do not experience any improvement. They may be disappointed that the steps they took did not allow them to reach their goals. 

    Inconveniences associated with the available options

    All the available options to improve mental capacities cause some inconveniences. These inconveniences are reviewed in the previous pages of this document. People who do not undertake any new treatment or changes to their lifestyle do not experience any of these inconveniences.

    Take the chance that things improve on their own

    For every 100 older adults experiencing a loss of autonomy, about 49 experience an improvement in their independence without undertaking any change to their lifestyle. 

    Take the time to find solutions on your own

    People who experience a loss of independence in daily activities may wish to take some time to find solutions by themselves, and to try to develop strategies that best suit their needs.

    Harms of Watchful Waiting
    Odds of maintaining or improving independence in daily activities

    People who choose watchful waiting without making any changes are less likely to improve their independence than those who choose one of the other options presented

    Risk of dying

    Actively monitoring the health of older adults identified as at rik of loosing their independence, increases their risk of dying

    • Learn more about the studies
      Studies description
      Death occurs within 7 years for...

      51% of independent older adult

      71% of older adults lacking independence in daily activitie

      20% of older adults​​​​​​​

      With Without Impact
      Confidence in these results: High

      Further research is very unlikely to change our confidence in the estimate of effect.

      Results from a well-designed cohort study without risk of bias

      Studies and references

      Jagger et al. [1993]. Ageing, 22[3], 190-197.

      Design: longitudinal cohort study; Participants: 1,203 individuals aged 75 years and older, living in the community and institutions; Intervention: watchful waiting; Follow-up: 5 and 7 years.

    Admission to a long-term care facility

    Actively monitoring the health of older adults identified as at risk of loosing their independence, increases their risk of being admitted to a long-term care facility.

    • Learn more about the studies
      Studies description
      Admission to a long-termcare facility occurs within 7 years for...

      5% of independent older adult

      17% of older adults lacking independence in daily activities

      12% of older adults

      With Without Impact
      Confidence in these results: Moderate

      Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

      Downgraded because of imprecision

      Studies and references

      Jagger et al. [1993]. Ageing, 22[3], 190-197.

      Design: longitudinal cohort study; Participants: 1,203 individuals aged 75 years and older, living in the community and institutions; Intervention: watchful waiting; Follow-up: 5 and 7 years.

    Feeling of helplessness

    Failing to make changes to one's lifestyle or undertake treatment to prevent loss of independence in daily activities can lead to feelings of helplessness and distress.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Sundsli et al. [2014]. Clin Interv Aging, 9, 95-103.

      Design: randomized controlled study; Participants: 30 individuals aged 75 years and older; Intervention: watchful waiting vs. self-care telephone talks; Follow-up: 19 weeks.

      Asakawa et al. [2000]. Int J Aging Hum Dev, 50[4], 319-328.

      Design: longitudinal study; Participants: 692 individuals aged 65 years or older who had high functional health status at the baseline; Intervention: watchful waiting across time (between baseline and 2 years); Follow-up: 2 years.

      Orellano et al. [2012]. Am J Occup Ther, 66[3] 292-300.

      Design: Systematic review; Participants: older adults living in the community (mean age >72 years ); Intervention: ADL interventions (included an activity-based or occupation-based component); Follow-up: varied from 10 weeks to 5 years.

    Quality of life

    Actively monitoring the heal of older adults identified at risk of loosing their independence, increases their risk of experiencing a decrease in their quality of life.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Orellano et al. [2012]. Am J Occup Ther, 66[3] 292-300.

      Design: Systematic review; Participants: older adults living in the community (mean age >72 years ); Intervention: IADL interventions (included an activity-based or occupation-based component); Follow-up: varied from 10 weeks to 5 years.

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  • Brain Exercises

    Consists of doing activities and games that stimulate mental capacities, e.g., reading, crosswords, sudoku. These activities can either be done individually, or in a group under the supervision of a professional.

    Benefits of Mental Exercises
    Ability to perform daily activities

    For every 100 older adults who do brain exercises, 11 maintain or improve their ability to perform daily activities due to the exercises.

    • Learn more about the studies
      Studies description
      Ability to perform daily activities is maintained or improved for...

      60% of older adults

      49% of older adults

      11% of older adults

      With Without Impact
      Confidence in these results: Very low

      Any estimate of effect is very uncertain.

      Downgraded because of risk of bias (lack of information about randomization, allocation concealment, blinding of participants and assessors) and potential risk of publication bias. 

      Studies and references

      Rebok et al. [2014]. J Am Geriatr Soc 62(1): 16-24.

      Design: randomized controlled trial; Participants: 2,832 older adults with mean age of 73.6 years; Intervention: memory training, reasoning training and speed processing; Follow-up: 10 years.

    Processing speed

    For every 100 older adults who do brain exercises, 22 maintain or increased their processing speed due to the exercises.

    • Learn more about the studies
      Studies description
      Processing speed is maintained or increased by...

      70% of older adults

      48% of older adults

      22% of older adults

      With Without Impact
      Confidence in these results: Very low

      Any estimate of effect is very uncertain.

      Downgraded because of risk of bias (lack of information about randomization, allocation concealment, blinding of participants and assessors) and potential risk of publication bias.

      Studies and references

      Rebok et al. [2014]. J Am Geriatr Soc 62(1): 16-24.

      Design: randomized controlled trial; Participants: 2,832 older adults with mean age of 73.6 years; Intervention: memory training, reasoning training and speed processing; Follow-up: 10 years.

    Harms of Mental Exercises
    Anxiety to do well

    Older adults may feel some anxiety to do well if brain exercises are done in a group.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated
      Studies and references

      Kueider et al. [2012]. PloS One : 7 : pages e40588.

      Design: Systematic literature review including 38 experimental studies; Participants: 3,205 individuals aged 55 years old or more, presenting with mild cognitive impairment; Intervention: Computer-based cognitive training during 2-68 weeks, and from 20-120 minutes a day,  depending on the study.

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  • Self-management Program
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    this option
  • Self-management Program

    Self-management support programs are educational and supportive interventions provided by healthcare staff to encourage people living with chronic diseases to take a more active role in their health. They aim to increase the person's skills and confidence in managing their own health problems. These programmes can include information about the disease; education to offer knowledge, skills, and strategies to manage the consequences of the disease/disability; social support through communication with other patients or professionals; and training.

    Benefits of Self-management Program
    Independence in daily activities

    Older adults who participate in self-management support programs are more likely to be independent in their daily activities compared to those who do not take part in such programs.

    • Learn more about the studies
      Studies description
      Confidence in these results: Very low

      Any estimate of effect is very uncertain.

      Downgraded because of risk of bias and heterogeneity

      Studies and references

      Van Het et al. [2016]. Int J Nurs Stud, 61, 230-247.

      Design: Systematic review of 12 randomized clinical trials; Participants: 3,101 individuals living in the community aged 64 and older; Intervention: Self-management support program defined as an educational and supportive intervention with the aim of increasing patients’ skills and confidence in managing their health problems; Follow-up: 12 weeks to 24 months.

    Unplanned hospital readmissions

    For every 100 adults who participate to a self management program, 12 to 17 avoid hospitalization during the first 30-day episode of homecare due to the program.

    • Learn more about the studies
      Studies description
      With self-management done by telephone, unplanned hospital readmissions are avoided by...

      72% of older adults

      55% of older adults

      17% of older adults

      With Without Impact
      With self-management provided in the home, unplanned hospital readmissions are avoided by...

      67% of older adults

      55% of older adults

      12% of older adults

      With Without Impact
      Confidence in these results: Low

      Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

      Downgraded because of risk of bias (missing information on allocation concealment and blinding [glossary link]  of outcome assessors) and imprecision

      Studies and references

      Chow et al. [2014]. J Adv Nurs 70[10]: 2257-2271.

      Design: randomized clinical trial; Participants: 281 individuals aged 65 years and older hospital-discharged with comorbidities; Intervention: nurse-led case management program; Follow-up: 12 weeks.

    Mobility

    Current research does not show any effect self-management support programs on mobility of oder adults.

    • Learn more about the studies
      Studies description
      Confidence in these results: Very low

      Any estimate of effect is very uncertain.

      Downgraded because of risk of bias (missing information on allocation concealment, blinding of participants and outcome assessors) and imprecision

      Studies and references

      Leveille et al. [1998]. J Am Geriatr Soc 46[10]: 1191-1198.

      Design: randomized clinical trial;  Participants: 201 chronically ill adults aged 70 and older recruited through medical practices; Intervention: A targeted, multi-component disability prevention and disease self-management program led by a geriatric nurse practitioner [GNP]; Follow-up: 12 months.

    Harms of Self-management Program
    Practical issues: Time

    Some older adults who take part in self-management programs find them strenuous due to the time involved.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated
      Studies and references

      Elzen et al. [2007]. Soc Sci  Med 46[9]: 1832-41.

      Design: randomized clinical trial; Participants: 139 people aged 59 or older with different comorbidities (lung disease, heart disease, diabetes, or arthritis); Intervention: The Chronic Disease Self-Management Program; Follow-up: 6 months.

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  • Smart homes

    Smart homes feature technologies that are integrated into the infrastructure of the residence to monitor what is happening and improve residents' experience at home. In healthcare, these technologies may be used to monitor the occupant’s health, for exemple their weight, pulse, blood pressure, falls and movements. They can also help maintain their well-being, for example by controlling the quality of the air.

    Benefits of Smart homes
    Ability to perform daily activities

    Older adults who live in smart homes are more likely to be able to perform daily activities compared to those who don't.

    • Learn more about the studies
      Studies description
      Confidence in these results: Low

      Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

      Downgraded because of risk of bias (lack of information about randomization, allocation concealment, blinding of participants and assessors, and high rate of attrition)

      Studies and references

      Tomita et al. [2007]. Topics in Geriatric Rehabilitation, 23[1], 24-34.

      Design: randomized controlled trial; Participants: 106 individuals with a mean age of 72 in intervention group and 75.6 in control group; Intervention: a computer with Internet access and X10-based smart home technology; Follow-up: 24 months.

      Pecina et al. [2013]. Qual Life Res 22(9): 2315-2321.

      Design: randomized controlled trial; Participants: 205 individuals aged 60 years and older; Intervention: daily home telemonitoring; Follow-up: 12 months.

    Hospitalization

    For every 100 adult who live in smart homes, 7 avoid hospitalization during the first 30-day episode of homecare due to the technologies.

    • Learn more about the studies
      Studies description
      Hospitalizations during the first 30-day episode of homecare are avoided by ...

      90% of older adults

      83% of older adults

      7% of older adults

      With Without Impact
      Confidence in these results: Low

      Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

      Downgraded because of risk of bias (non experimental retrospective study)

      Studies and references

      Chen et al. [2011]. Am J Manag Care 17(6): e224-e230.

      Design: retrospective nonexperimental study; Participants: 5,873 Medicare beneficiaries aged 65 years and older, receiving home health services through a network of community-based home health agencies operating in the states of Texas and Louisiana; Intervention: integrated, clinician-focused telehealth monitoring system; Follow-up: 1 year.

    Health

    The current research shows smart home technologies do not help older adults avoid disease, illness, or injury.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Demiris et al. [2008]. Med Inform: 33-40.

      Design: Systematic review; Participants: older adults, people with cognitive impairment and general population; Intervention: technologies for functional monitoring, safety monitoring, physiological monitoring, cognitive support sensory aids, and to increase social interaction; Follow-up: not mentioned.

    Harms of Smart homes
    Dependence on technology

    Some older adults are worried about becoming overly reliant on these technologies.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Chung  et al. [2016]. Annu Rev Nurs Res 34: 155-181.

      Design: Integrative literature review including 16 studies with multiple designs; Participants: 7 to 119 older adults and caregivers; Intervention: smart home technologies (various sensors: motion, bed, stove, door, etc.); Follow-up: not mentioned.

    Practical issues: Cost

    In most cases, living in smart homes requires the purchase and installation of equipment. If the technology needs to be connected to the Internet or to a Web portal, then a monthly fee is also charged (ranging from $130 to $150 per month).

    Practical issues: Access

    Some older adults who live in remote or under-served urban areas may have difficulty accessing smart home technologies.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Chung  et al. [2016]. Annu Rev Nurs Res 34: 155-181.

      Design: Integrative literature review including 16 studies with multiple designs; Participants: 7 to 119 older adults and caregivers; Intervention: smart home technologies (various sensors: motion, bed, stove, door, etc.); Follow-up: not mentioned.

    Practical issues: Difficulty in learning how to use sensors and technology

    Some older adults lack familiarity with computers and it can be difficult for them to learn how to use smart home technologies.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Tomita et al. [2007]. Topics in Geriatric Rehabilitation, 23[1], 24-34.

      Design: randomized controlled trial; Participants: 106 individuals with a mean age of 72 in intervention group and 75.6 in control group; Intervention: a computer with Internet access and X10-based smart home technology; Follow-up: 24 months.

    Practical issues: Obtrusiveness

    Location of technologies in the home (i.e., in the bedroom or bathroom) or types and size of devices may be obtrusive.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Chung  et al. [2016]. Annu Rev Nurs Res 34: 155-181.

      Design: Integrative literature review including 16 studies with multiple designs; Participants: 7 to 119 older adults and caregivers; Intervention: smart home technologies (various sensors: motion, bed, stove, door, etc.); Follow-up: not mentioned.

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  • Rehab or Occupational Therapy at Home
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    this option
  • Rehab or Occupational Therapy at Home

    Rehab (rehabilitation) or occupational therapy at home is provided by healthcare workers in various professions, as part of homecare services, more often occupational therapist, physiotherapists, and nurses. It allows people to continue to go about their daily activities and tasks in an independent manner, based on their own goals. After an initial assessment, the healthcare provider prepares an action plan detailing care, preventative measures, and rehabilitation to help compensate for the person's limitations. It can take at least 6 weeks to complete, depending on the person's needs.

    Benefits of Rehab or Occupational Therapy at Home
    Ability to perform daily activities

    For every 100 older adults receiving rehab or occupational therapy at home, 25 improve their ability to perform daily activities due to this intervention.

    • Learn more about the studies
      Studies description
      Ability to perform daily activities is improved for...

      56% of older adults

      31% of older adults

      25% of older adults

      With Without Impact
      Confidence in these results: Moderate

      Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

      Downgraded because of risk of bias (no blinding of participants and assessors). 

      Studies and references

      Tuntland et al. [2015]. BMC Geriatr 15: 145.

      Design: Randomized clinical trial; Participants: 61 home-dwelling older adults with functional decline in one or more daily activities living in rural areas (Norway); Intervention: reablement intervention including maximum rehabilitation period of 3 months, training in daily activities, adaptations to the environment or the activity, and exercise programs; Follow-up: 9 months.

    Risk of dying

    Current research shows that receiving rehab or occupational therapy at home does not reduce older adults' risk of dying.

    • Learn more about the studies
      Studies description
      Confidence in these results: Very low

      Any estimate of effect is very uncertain.

      Downgraded because of risk of bias (missing information on allocation concealment, incomplete data outcome and blinding of participants and assessors) and imprecision. 

      Studies and references

      Lewin et al. [2013]. Health & social care in the community 22[3]: 328-336.

      Design: Randomized controlled trial; Participants: 750 older adults with a mean age of 82 years, needing assistance with one or more activities of living; Intervention: homecare reablement including strength, balance and endurance exercises to improve or maintain mobility; Follow-up: 24 months.

    Emergency department visits

    For every 100 older adults who receive rehab or occupational therapy at home, 10 avoid emergency department visits due to this intervention. 

    • Learn more about the studies
      Studies description
      Emergency department visits are avoided by..

      90% of older adults

      80% of older adults

      10% of older adults

      With Without Impact
      Confidence in these results: Low

      Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

      Downgraded because of risk of bias (no randomization, incomplete data outcome and no blinding of participants and assessors). 

      Studies and references

      Tinetti et al. [2002]. Jama 287 [16]:2098-2105.

      Design: Controlled clinical trial; Participants: 691 individuals aged 65 years or older at risk of functional decline after acute illness or hospitalization but with the potential for maintaining or improving their function; Intervention: Restorative care; Follow-up: 2 years.

    Hospital admissions

    The current research does not show any effect of rehab or occupational therapy at home to avoid hospital admission of older adults.

    • Learn more about the studies
      Studies description
      Confidence in these results: Very low

      Any estimate of effect is very uncertain.

      Downgraded because of risk of bias (missing information on allocation concealment, blinding of participants and assessors and incomplete data outcome).

      Studies and references

      Lewin et al. [2013]. Health & social care in the community 22[3]: 328-336.

      Design: Randomized controlled trial; Participants: 750 older adults with a mean age of 82.28 years, needing assistance with one or more activities of living; Intervention: homecare reablement including strength, balance and endurance exercises to improve or maintain mobility; Follow-up: 24 months.

    Admission to a long-term care facility

    For every 100 older adults receiving rehab or occupational therapy in the home, 11 avoid admission to a long-term care facility due to this intervention.

    • Learn more about the studies
      Studies description
      Admission to a long-term care facility is avoided by...

      82% of older adults

      71 % of older adults

      11 % of older adults

      With Without Impact
      Confidence in these results: Low

      Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

      Downgraded because of risk of bias (missing information on allocation concealment, blinding of participants and assessors and incomplete data outcome).

      Studies and references

      Tinetti et al. [2002]. Jama 287 [16]:2098-2105.

      Design: Controlled clinical trial; Participants: 691 individuals aged 65 years or older at risk of functional decline after acute illness or hospitalization but with the potential for maintaining or improving their function; Intervention: Restorative care; Follow-up: 2 years.

    Harms of Rehab or Occupational Therapy at Home
    Unmet needs

    Some older adults feel that rehab or occupational therapy in the home do not meet all their needs because... 

    • they were not consulted or informed enough before reablement
    • the time spent for reablement was too short
    • they observed a lack of standardized care from the various professionals.
    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Non évalué en raison de l’absence d’une estimation de l’effet.

      Studies and references

      Patient and Client Council. [2012]. Care at Home - Older people’s experiences of domiciliary care.

      Design: cross-sectional survey; Participants: 1,161 Northern Irish adults aged 65 years and older receiving domiciliary care service and their carers; Intervention: Domiciliary care; Follow-up: no follow-up.

      Glendinning et al. [2010]. ISBN 978-1-907265-08-2.

      Design: longitudinal study; Participants: 1,015 individuals aged 65 years and older; Intervention: homecare reablement services offered in five councils; Follow-up: 12 months.

    Practical issue: Acces to occupational therapy

    There may be delays in accessing public rehabilitation or occupational therapy services. This type of service is also offered in the private sector, but it must be paid for.

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  • Yoga

    Yoga includes physical, mental, and spiritual practices that originated in ancient India. It involves holding stretches as a kind of low-impact physical exercise, and may involve meditation, visualization, breathing exercises, and music.

    Benefits of Yoga
    Balance

    For every 100 older adults who do yoga, 63 increase their balance due to yoga. 

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      Studies description
      Balance is increased for...

      100% of older adults

      37% of older adults

      63% of older adults

      With Without Impact
      Confidence in these results: Moderate

      Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

      Downgraded because of imprecision in the results.

      Studies and references

      New meta-analysis by the Decision Box team based on the results reported in Youkhana et al. [2016]. Age Ageing, 45 [1], 21-29.

      Design: Systematic review and meta analysis of 5 randomized controlled trials on balance; Participants: 307 older people with a mean age ranging from 63 to 84 years; Intervention: 60–90 min of yoga, 1–2 times per week, for 8–24 weeks in total; Follow-up: Varied from 8 to 24 weeks.

    Mobility

    Older people who do yoga are more likely to have a normal mobility compared to those who don't.

    • Learn more about the studies
      Studies description
      Confidence in these results: Moderate

      Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

      Downgraded because of imprecision in the results. 

      Studies and references

      Based on a new meta-analysis done by the Decision Box team, and based on Youkhana et al. [2016]. Age Ageing, 45 [1], 21-29.

      Design: Systematic review and meta analysis of 3 randomized controlled trials on mobility; Participants: 307 older people with a mean age ranging from 63 to 84 years; Intervention: 60–90 min of yoga, 1–2 times per week, for 8–24 weeks in total; Follow-up: Varied from 8 to 24 weeks.

    Harms of Yoga
    Muscle or bone pain

    Older adults who do yoga may experience minor adverse events such as knee pain, lower back pain, or minor muscle strain. Some may also experience a worsening of existing lower back pain.

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      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Youkhana et al. [2016]. Age Ageing 45 [1]: 21-9.

      Design: Systematic review with meta-analysis of 6 randomized controlled trials, including 3 trials on physical mobility; Participants: 307 people with a mean age ranging from 63 to 84 years; Intervention: 60–90 min of yoga, 1–2 times per week; Follow-up: Varied from 8 to 24 weeks.

      Tiedemann et al. [2013]. J Gerontol A Biol Sci Med Sci, 68 [9]: 1068-75.

      Design: Pilot randomized controlled trial reporting results on mobility; Participants: 54 people aged 59 to 87 years with a mean age of 68 years; Intervention: twice-weekly group-based program of Iyengar-style yoga; Follow-up: 12 weeks.

      Cheung et al. [2014]. BMC Complement Altern Med 14 : 160.

      Design: Pilot randomized controlled trial reporting results on osteoarthritis outcomes; Participants: 36 people with a mean age of 72 years; Intervention: one 60-minute Hatha yoga class per week; Follow-up: from 8 to 20 weeks.

    Practical issues: Time required

    To feel the benefits, the person generally needs to do yoga for 60 minutes or more at a time, 1 to 2 times a week, and for at least 8 weeks. This takes time.

    • Learn more about the studies
      Studies description
      Confidence in these results: Not evaluated

      Not evaluated due to a lack of an estimate of effect.

      Studies and references

      Youkhana et al. [2016]. Age Ageing, 45 [1], 21-29.

      Design: Systematic review of 6 randomized controlled trials, including 3 trials on physical mobility; Participants: 90 older adults with a mean age ranging from 63 to 84 years; Intervention: 60–90 min of yoga, 1–2 times per week, for 8–24 weeks in total; Follow-up: Varied from 8 to 24 weeks.

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Version 1.0

Publication date: August 2018 - Evidence update: May 2018 - Next update: May 2020