Review
Effects of self-management support programmes on activities of daily living of older adults: A systematic review

https://doi.org/10.1016/j.ijnurstu.2016.06.014Get rights and content

Abstract

Background

The ability of older adults to carry out activities of daily living and to adapt and to manage their own life decreases due to deterioration of their physical and cognitive condition. Nurses and other health care professionals should support the self-management ability of older adults to prevent activities of daily living dependence and increase the ability to adapt and to self-manage the consequences of living with a chronic condition.

Objective

To gain insight into the evidence of the effects of self-management support programmes on the activities of daily living of older adults living at home.

Design

A systematic literature review of original research publications.

Data sources

Searches were performed in PubMed, CINAHL, PsychInfo, EMBASE and the Cochrane Central Register of Controlled Trials (in February 2016). No limitations were applied regarding date of publication, language or country.

Review methods

Publications were eligible for this review on condition that they described a self-management support programme directed at adults of on average 65 years or older, and living in the community; used a randomized control group design; and presented information about the effects on activities of daily living. The methodological quality of the included studies was independently assessed by the authors using the quality criteria for reviews of the Cochrane Effective Practice and Organisation of Care Review Group. A best evidence synthesis was performed using guidelines provided by the Cochrane Collaboration Back Review Group.

Results

A total of 6246 potentially relevant references were found. After screening the references, 12 studies with a randomized controlled trial design were included. The methodological assessment of the 12 studies indicated variations in the risk of bias from low (n = 1) to unclear (n = 3) and high (n = 8). Although there was considerable variation in study population, intervention characteristics and measurement instruments used, most studies (n = 11) showed effects of self-management support programmes on the activities of daily living of older adults.

Conclusions

There is a moderate level of evidence that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults.

Further research is required to gain insight into the most appropriate context and approach of self-management support interventions targeting activities of daily living of older adults living in the community.

Introduction

In the years to come, health care professionals will be challenged to provide quality health care for increasing numbers of older and frail people with limited health care resources. For many elderly people, life at an advanced age is pleasant, but most elderly people are also confronted with long-term disabilities, chronic illnesses and other health problems that impact the ability to perform activities of daily living (CSO et al., 2012). Activities of daily living are defined as routine activities that people tend to do every day and are performed to live independently. Activities of daily living consist of basic activities of daily living, such as eating, bathing, dressing, toileting, transferring (walking) and continence (Katz et al., 1963), and instrumental activities of daily living, like the ability to use the telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for own medication and the ability to handle finances (Lawton and Brody, 1969).

Frail people, in particular, are at high risk of decreased mobility and dependence in activities of daily living (Fried et al., 2001). Effective interventions aimed at preventing activities of daily living disability may diminish the burden that frailty places on elderly people, care providers and the health care system as a whole (Vermeulen et al., 2011). Nurses and other health care professionals have a critical role in the implementation of future preventive treatment interventions for frailty (Rochat et al., 2010). In addition, active involvement of the older adults is a key component, which is in line with the principles of care according to ‘self-management’ (Barlow et al., 2002, Pulvirenti et al., 2014). Self-management is defined as the management of the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition (Barlow et al., 2002). Efficacious self-management encompasses the ability to monitor one's condition and to effect the cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life (Barlow et al., 2002). However, people need support from health care professionals and significant others to be able to self-manage (Dwarswaard et al., 2015). Particularly at a later age, the ability to carry out activities of daily living and to adapt and to manage one's own life decreases due to the deterioration of one's physical and cognitive condition. In line with this, health care professionals should support the self-management ability of older adults with interventions aimed at empowering elderly people (CSO et al., 2012). Self-management support interventions are defined as all educational and supportive interventions, systematically provided by health care staff, to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting and problem-solving support (Adams et al., 2004). By supporting the self-management ability of older adults, nurses and other health care professionals can contribute to the prevention of activities of daily living dependence and increase the ability to adapt and to self-manage the consequences of living with a chronic condition. Pursuant to the above considerations, the main objective of this systematic review was to identify, appraise and synthesize the evidence of the effects of self-management support programmes on the activities of daily living abilities of older adults.

The main review question was:

  • -

    What evidence can be derived from existent studies about the effects of self-management support programmes on the activities of daily living abilities of older adults?

    In order to interpret and value the effects properly, two additional questions were formulated, namely:

  • -

    What are the characteristics of effective self-management support programmes in the relevant studies?

  • -

    What is the methodological quality of the relevant studies?

Section snippets

Method

The methodology used for this systematic review was based on the guidance for conducting systematic reviews, the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green, 2011).

Results

To appraise and synthesize the evidence of the effects of self-management support programmes on the activities of daily living of older adults, the characteristics and the methodological quality of the included studies and the characteristics of the self-management support programmes are described in Table 1, Table 2, respectively.

Discussion

This review showed that self-management support programmes can contribute to the activities of daily living of older adults living in the community. In seven of the 12 included studies (both with a low and high risk of bias), the self-management support programme led to a statistically significant difference in the activities of daily living between the results of the intervention group and those of the control group (Alp et al., 2007, Coleman et al., 2012, Ersek et al., 2003, Friedman et al.,

Conclusion

There is a moderate level of evidence that self-management support programmes with a multi-component structure, containing disease-specific information, education of knowledge and skills and, in particular, individually tailored coaching, improve the activities of daily living of older adults.

The findings provided by this review might be useful for nurses and other health care professionals who intend to design tailored self-management support interventions for older adults to remain

Contributions

The authors would like to thank Dr. Ad Bergsma of the Centre for Nursing Research at Saxion University of Applied Sciences for his writing assistance and proofreading the manuscript.

Conflict of interest

All authors disclose no conflict of interest.

Funding

No external funding was received.

Ethical approval

The authors declare that no ethical approval was required for this systematic literature study.

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