The effect of older-person centered and integrated health management model on multiple lifestyle behaviors: A randomized controlled trial from China
Introduction
Non-communicable diseases (NCDs) remain a leading cause of disability and death (Allen et al., 2017) and represent an economic burden worldwide (Ding et al., 2016). About 60% of NCDs are caused by modifiable risk factors, including smoking, non-moderate drinking consumption, unhealthy diets and inadequate physical activity (Joseph et al., 2017). This situation is proof that multiple healthy lifestyle factors are strongly associated with NCDs (Bellack, 2017; Ogawa et al., 2017). The elderly have the highest prevalence of chronic diseases (Organization, 2017a, Organization, 2017b, 2018; Zhao et al., 2017). As the age of the global population continues to increase, an increasing number of elderly people may adopt multiple unhealthy lifestyle behaviours simultaneously (Organization, 2017a,b, 2018). Previous studies have shown that certain health risk behaviours occur in combination and tend to accumulate in individuals (Orleans, 2004), leading to greater risk of disease and increased health care costs (Joseph et al., 2017; Linardakis et al., 2014). Fortunately, some studies have shown that people who adopt a greater number of healthy lifestyle habits live longer and have a better health-related quality of life (HRQOL) (Ding et al., 2016; Leila et al., 2015). Indeed, even in very advanced years, adopting healthy lifestyle habits can have powerful benefits for health and wellbeing (Organization, 2017a,b, 2018; Woo et al., 2002). Therefore, there is an urgent need to develop a broad, comprehensive and effective intervention for multiple healthy lifestyle factors (Organization, 2017a,b, 2018).
To date, few studies have investigated effective interventions for multiple healthy lifestyle factors (upstream intervention studies). Moreover, these few studies have been published mainly in the United States, Australia, Europe and other developed countries (Leila et al., 2015). Pronk et al. mainly demonstrated the policy feasibility of multiple health behaviour interventions and called on patients, clinicians, health system leaders and policy makers to work together to develop viable solutions and implement them immediately (Pronk, Peek, & Goldstein, 2004). Vandelanotte reported that computerized tailored interventions and simultaneous intervention models had the same effect in promoting physical activity and reducing the fat intake (FI) for participants aged 20–60 years (Brug, 2008). Sanjoti used a summary of health scores or lifestyle scores as an indicator for adults aged 18–70 years to assess the effect of a computerized, tailor-made, multiple intervention model and found that the model simultaneously improved drinking and healthy diet habits; however, the effect of the intervention on smoking and physical activity was not obvious (Parekh et al., 2012). Leila found that cardiac rehabilitation interventions and usual care in adults with CHD in New Zealand showed a positive effect on compliance with behavioural changes at 3 months compared to usual care alone. Nevertheless, did not extend the intervention to 6 months ended (Leila et al., 2015). Most downstream intervention studies have focused on the distribution of multiple healthy lifestyle behaviours in a population either singly or in combination to identify positive health outcomes that meet the recommended healthy lifestyle guidelines (Larsson et al., 2017; Myint et al., 2011, 2013; Pronk, Anderson et al., 2004; Woo et al., 2002). Today, a limited number of multiple healthy lifestyle factor intervention models have been evaluated and often have shown promising results (Leila et al., 2015; Parekh et al., 2012). However, the long-term paradigm of improving multiple healthy lifestyle factors (smoking, risky drinking, lack of physical activity, and unhealthy diets) has yet to take shape.
The aim of this study was to investigate the effectiveness of an older person-centred and integrated health management model programme (OPCHMP) to improve adherence to recommended lifestyle behaviours (ATHLBS), in addition to usual care, in the elderly of China. We hypothesized that participants receiving OPCHMP would have greater ATHLBS after the intervention than those who received usual care alone. The secondary objectives included exploring the effects of the intervention on blood pressure, fasting plasma glucose, waist circumference and total cholesterol.
Section snippets
Subjects and methods
This research is a 24-month, 2-arm; parallel randomized controlled trial (RCT) design. It was being implemented in some community health service centres in Nanjing. We recruited participants should be aged 60 years and older and have lived for a long time (2 years) in the community. Those with cognitive deficits, severe chronic illnesses, multiple life-threatening comorbidities, and life expectancy less than one year, current or previous participation in another trial within the past 30 days
General characteristics of the subjects
The characteristics of the intervention and control group subjects at baseline are shown in Table 1. In total, 14 participants dropped out of the intervention group, for a dropout rate of 4.15%, and 20 participants dropped out of the control group, for a dropout rate of 5.99%. There was no significant difference in the dropout rates between the two groups. The main reasons for dropping out were moving, travelling, withdrawal and death. The average age of the participants was 70.53 years, 48.14%
Discussion
The results of this study are true and reliable. ATHLBS is assessed by a composite score, which not only controls type 1-error rates (Drake et al., 2013), but also provides a clear picture of the overall impact of the intervention. The results showed that the OPCHMP intervention improved ATHLBS at 12 months when compared to usual care alone (control), although the size of effect was not significantly retained at 24 months, However, the AOR found that baseline (1.22), 12 months (1.16) and 24
Conclusion
In conclusion, the 24-month follow-up intervention of OPCHMP can improve multiple health behaviors, including smoking, drinking, health dietary, weekly physical activity durations, and comprehensive health. Meanwhile, objective health indicators such as systolic blood pressure, diastolic blood pressure, waist circumference, fasting blood glucose and total cholesterol were also optimized. This is a very encouraging result, maybe we should use it to contribute to healthy aging worldwide.
Funding
This work was supported by the National Natural Science Foundation of China (Grant Number 81273189).
Conflicts of interest
None declared.
Acknowledgements
The authors thank the participants and the Qinhuai Hospital, Nanjing, Jiangsu, China, for assisting in this study.
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