Ignite Creation Date:
2024-10-26 @ 3:41 PM
Last Modification Date:
2024-10-26 @ 3:41 PM
Study NCT ID:
NCT06616935
Status:
NOT_YET_RECRUITING
Last Update Posted:
None
First Post:
2024-09-24
Brief Title:
Beyond Older Adults39 Reablement
Sponsor:
None
Organization:
None
Study Overview
Official Title:
Routine Referrals to Third Sector Organisations Following Reablement to Target Loneliness Among Older Adults Aged 65years and Over
Status:
NOT_YET_RECRUITING
Status Verified Date:
2024-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The goal of this feasibility study is to find out if routine referrals of older adults aged 65years and over to community activities provided by third sector organisations will reduce their loneliness risk
The main question being asked is In the care of older adults aged 65 years and over discharged as independent from ICT does routinely referring to third sector organisations reduce their loneliness risk and recurrent hospital admissions
Researchers will compare referrals of older adults to community activities following reablement provided by intermediate care to attendance of online activities to find out which will be effective in reducing loneliness risk of older adults aged 65years and over Researcher will also find out if it will be feasible to complete a full randomised controlled trial
The main question being asked is In the care of older adults aged 65 years and over discharged as independent from ICT does routinely referring to third sector organisations reduce their loneliness risk and recurrent hospital admissions
Researchers will compare referrals of older adults to community activities following reablement provided by intermediate care to attendance of online activities to find out which will be effective in reducing loneliness risk of older adults aged 65years and over Researcher will also find out if it will be feasible to complete a full randomised controlled trial
Detailed Description:
Introduction The older adult population is increasing in England and Wales In 2001 there were 83million aged 65years and over compared to 11million in 2021 This has resulted in their increased hospital admissions with subsequent use of reablement following discharge Older adults will be used to represent those aged 65years and over for this study
Reablement aims at increasing independence of older adults and is being used to reduce their care cost However there is an apparent contradiction in that many older adults are often socially isolated following an episode of reablement Loneliness has also been reported among older adults and this has the potential of impacting on their psychological and physical wellbeing
This research will investigate the impact of routinely referring older adult reablement recipients to services in the community neither public nor private sector known as third sector organisations National Audit Office that target loneliness to reduce their recurrent admissions to hospitals It will be carried out in an Intermediate Care Team providing reablement in the East Midlands of England Background Reablement is a short-term up to six weeks programme aimed at relearning skills that are lost through ill health Locally Intermediate Care Team ICT of the National Health Service NHS facilitates and prevents admissions from hospitals by providing reablement at the home of patients in the County being studied ICT is however commissioned to discharge patients within 17 days of admission to its caseload It is not clear whether reablement programmes are set to address longer-term issues of recipients during and after the service Support systems after the service of those who emerge independent are also not clear These were noted from a service evaluation carried out by the researcher and other researchers have also note the paradoxical increase in hospital admissions following reablement of older adults These could be related to the psychological and physical factors affecting recipients who emerge independent and end up living alone with no services involved Literature Review There is a plethora of literature on the positive impacts of reablement on the physical abilities of older adults Older adult recipients find it beneficial and report increase independence of their activities of daily living Some recipients have also been reported to have reduced home care leading to reduction in financial cost of care Positive mental wellbeing and social functioning of some recipients have been reported
There is however a paucity of literature on the impact of loneliness on older adults who receive reablement particularly those who are discharged as independent but have no family support As reablement promotes independent living there could be a possibility of some recipients being at risk of loneliness and isolation efficient ways of maintaining the quality of life of older adults is needed amidst the increase in the older adult population and budget cuts of local governments In studies to find out the effectiveness of interventions to reduce loneliness among older adults their active participation in group activities has been found to limit their loneliness Other studies however did not find group interventions more effective compared to one- to- one interventions in tackling older adults loneliness Some studies also did not find social intervention effective in reducing loneliness Video conferencing has been found effective in directly and indirectly reducing loneliness among older adults They however note the health inequalities associated with its use Social prescribing helps patients access nonclinical support This is however mainly available through some General Practitioner GP services The older adult patients described in this study might likely not be accessing such support The Innovation Potential This study will ascertain third sector organisations currently available in the community for older adults deemed as independent after receiving reablement with stakeholders It will explore whether these services are sufficient or appropriate to meet the needs of older adults who are socially isolated and at risk of loneliness Older adults will be involved in the development of the project to identify solutions This will add to the evidence base for longer-term impact beyond the initial reablement episode Aim To find out whether routine referrals to third sector organisations of older adults who have been discharged as independent from ICT will be effective in reducing their loneliness risk and recurrent hospital admissions Objectives Objective 1 To complete a literature review on older adults loneliness and reablement Objective 2 To identify third sector organisations available in the local area for socially isolated older adults Objective 3 To co design questions for semi structured interviews of older adult ICT patients to be referred to the identified third sector organisations following reablement with an older adult Patient and Public Interest PPI group
Objective 4 To conduct a feasibility study of routinely referring older adults to the identified third sector organisations with pre and post semi structured interviews following discharge from ICT to determine its effectiveness in reducing loneliness risk and recurrent hospital admissions Objective 5 To estimate the rate of eligible older adults who are willing to participate those who will drop out and those who will comply with the allocated intervention to assist in the design of a full randomised controlled trial Research Design and Methods This will be an applied health research employing empirical method It will be mixed methods research of both quantitative feasibility and qualitative semi structured interviews methods in five phases The phases will be literature review service mapping followed by a participatory action research PAR approach to co design questions for the semi structured interviews for participants in the feasibility study phase The feasibility study will be to implement outcomes from the second and third phases for effectiveness and feasibility for a larger scale randomised controlled trial A sample of the participants will be interviewed pre and post the interventions for triangulation Hussein 2009 The final phase will be estimation of the rate of eligible participants willing to participate those who will drop out and those who will comply with the intervention to assist in designing a full randomised controlled trial A pragmatism epistemology will be assumed to allow a co-produced solution to the research question Setting Reablement service provided through ICT in the East Midlands of England due to the service facilitating discharges from hospitals but also experiencing recurrent admissions to its caseload Process Phase one Literature review A systematic approach of searching the literature through appropriate databases will be used to complete the literature review
The literature will be reviewed on the definition of loneliness and its appropriate measurement with respect to older adults The impact of loneliness on older adults and the interventions for tackling loneliness among older adults will also be reviewed Reablement being provided in facilitating and preventing hospital admissions will also be reviewed Phase two Service mapping exercise The public health departments of the county being studied will be contacted to get information on the available services for older adults in the community The local Age United Kingdom UK charity services Church of England churches Salvation Army churches Baptist churches libraries Caribbean Groups African groups Asian Groups Sikh Community will also be contacted for information on their available services These have been identified as stakeholders in older adult care in the county Therapy colleagues from the workplace will also be engaged for their input on available services within the county
Phase three
Co Designing with Patient and Public Interest PPI Group A Participatory Action Research PAR approach has been employed to engage a PPI group The PPI group was made of four older adults and were consulted on a one-to-one basis The PPI group helped in developing the questions to be asked in the semi structured interviews This is to allow a co-production of the questions for the semi structured interviews for the feasibility phase The Research Development Service RDS advocates the involvement of PPI group in health research as they would have a better experience of what is being researched Studies have shown that older adults wish to be involved in project development and delivery Interventions that involve users in design and implementation are more successful
Phase four
Feasibility Study Quantitative study Older adults about to be discharged from ICT independently faced with loneliness will be approached for participation Potential participants who show interest and give informed written consent will have the 11 item De Jong Gierveld loneliness scale administered to identify their loneliness risk This has been chosen over the 3 item University of California Los Angeles UCLA loneliness scale as it measures items specific to the research with respect to isolation and loneliness Those identified as at risk of loneliness score of at least 3 will be included in the study and those not at risk will no longer be included They will then be assigned randomly to the intervention groups using sealedenvelopecom The researcher who is also the chief investigator will have no access to the allocation sequence
Participants in the intervention one group will have a choice of the activities in the community they would like to attend Participants in the intervention two group will attend weekly online seated and standing exercises and discussions via TEAMS led by the researcher Participants physical and mental wellbeing will be measured with the EQ-5D-5L scale and demographic data of age sex ethnicity marital status and whether they have family will be taken Their frailty Index score will be noted pre and post the study These will help gain background information about the participants
Semi Structured Interviews Qualitative Study Semi structured interviews will be conducted with some randomly selected participants from both groups pre and post intervention The interviews are expected to last for up to one hour and will be recorded with a password protected audio recorder
Phase five
Estimating the participating rate The number of participants willing to take part those who will drop out comply with the interventions and sample size for the actual randomised controlled trial will be determined
Data analysis The interviews will be organised using NVivo 12 and analysed using thematic analysis to obtain the main themes Two-way ANOVA Analysis of Variance intervention one group verses intervention two group and pre-test verses post-test will be conducted using SPSS software to analyse data from the feasibility study Demographic data will also be analysed with the SPSS software The participating rate sample size as well as the standard deviation of the main outcome measure De Jong Gierveld Loneliness scale will be determined for the actual randomised controlled trial Hypothesis to be tested
1 There is no difference in the De Jong Gierveld loneliness scores between older adults who attended community activities for six months and those who attended online activities for six months
2 There is no difference in EQ 5L 5D scores between older adults who attended community activities for six months and those who attended online activities for six months
3 There is no difference in the frailty scores between older adults who attended community activities for six months and those who attended online activities for six months
Ethical Considerations Permission to complete the study will be sought from ICT managers Ethical approval will be sought from the Integrated Research Application System IRAS Health Research Authority HRA and the University of Northampton Ethics Committee
Potential Participants will be issued Participant Information Sheets and given seven days to read understand and ask questions The participant information sheet has been checked by two older adults for language and clarity
Informed written consent will be sought from participants prior to taking part in the study and they will be informed of their right to withdraw up to the data analysis stage through the participant information sheets without repercussions according to the declaration of Helsinki World Medical Association 2013 Participants who will be selected for the semi structured interviews will have to sign a second consent form specific to the interview
Participants data will be anonymised to remove identifiable information for their confidentiality The data will be stored securely in accordance with the General Data Protection Regulation GDPR 2018 in the University of Northamptons SharePoint
During the study if a participant lacks capacity they will no longer be included in the study from when they lack capacity Their data from when they had capacity will be included in the study and no further data will be collected from them Participants will be made aware of this through the participant information sheets The researcher coming from an African background where older adults are rarely left on their own had a culture shock knowing in the UK some older adults become at risk of loneliness Coupled with the fact that the researcher has worked in older adult reablement for over 12years and part of the current team under study the researcher is passionate about improving the quality of life of older adults and hence the motivation for the study Being mindful of these the researcher will approach the study with an enquiry mind to allow a co-produced outcome
Reablement aims at increasing independence of older adults and is being used to reduce their care cost However there is an apparent contradiction in that many older adults are often socially isolated following an episode of reablement Loneliness has also been reported among older adults and this has the potential of impacting on their psychological and physical wellbeing
This research will investigate the impact of routinely referring older adult reablement recipients to services in the community neither public nor private sector known as third sector organisations National Audit Office that target loneliness to reduce their recurrent admissions to hospitals It will be carried out in an Intermediate Care Team providing reablement in the East Midlands of England Background Reablement is a short-term up to six weeks programme aimed at relearning skills that are lost through ill health Locally Intermediate Care Team ICT of the National Health Service NHS facilitates and prevents admissions from hospitals by providing reablement at the home of patients in the County being studied ICT is however commissioned to discharge patients within 17 days of admission to its caseload It is not clear whether reablement programmes are set to address longer-term issues of recipients during and after the service Support systems after the service of those who emerge independent are also not clear These were noted from a service evaluation carried out by the researcher and other researchers have also note the paradoxical increase in hospital admissions following reablement of older adults These could be related to the psychological and physical factors affecting recipients who emerge independent and end up living alone with no services involved Literature Review There is a plethora of literature on the positive impacts of reablement on the physical abilities of older adults Older adult recipients find it beneficial and report increase independence of their activities of daily living Some recipients have also been reported to have reduced home care leading to reduction in financial cost of care Positive mental wellbeing and social functioning of some recipients have been reported
There is however a paucity of literature on the impact of loneliness on older adults who receive reablement particularly those who are discharged as independent but have no family support As reablement promotes independent living there could be a possibility of some recipients being at risk of loneliness and isolation efficient ways of maintaining the quality of life of older adults is needed amidst the increase in the older adult population and budget cuts of local governments In studies to find out the effectiveness of interventions to reduce loneliness among older adults their active participation in group activities has been found to limit their loneliness Other studies however did not find group interventions more effective compared to one- to- one interventions in tackling older adults loneliness Some studies also did not find social intervention effective in reducing loneliness Video conferencing has been found effective in directly and indirectly reducing loneliness among older adults They however note the health inequalities associated with its use Social prescribing helps patients access nonclinical support This is however mainly available through some General Practitioner GP services The older adult patients described in this study might likely not be accessing such support The Innovation Potential This study will ascertain third sector organisations currently available in the community for older adults deemed as independent after receiving reablement with stakeholders It will explore whether these services are sufficient or appropriate to meet the needs of older adults who are socially isolated and at risk of loneliness Older adults will be involved in the development of the project to identify solutions This will add to the evidence base for longer-term impact beyond the initial reablement episode Aim To find out whether routine referrals to third sector organisations of older adults who have been discharged as independent from ICT will be effective in reducing their loneliness risk and recurrent hospital admissions Objectives Objective 1 To complete a literature review on older adults loneliness and reablement Objective 2 To identify third sector organisations available in the local area for socially isolated older adults Objective 3 To co design questions for semi structured interviews of older adult ICT patients to be referred to the identified third sector organisations following reablement with an older adult Patient and Public Interest PPI group
Objective 4 To conduct a feasibility study of routinely referring older adults to the identified third sector organisations with pre and post semi structured interviews following discharge from ICT to determine its effectiveness in reducing loneliness risk and recurrent hospital admissions Objective 5 To estimate the rate of eligible older adults who are willing to participate those who will drop out and those who will comply with the allocated intervention to assist in the design of a full randomised controlled trial Research Design and Methods This will be an applied health research employing empirical method It will be mixed methods research of both quantitative feasibility and qualitative semi structured interviews methods in five phases The phases will be literature review service mapping followed by a participatory action research PAR approach to co design questions for the semi structured interviews for participants in the feasibility study phase The feasibility study will be to implement outcomes from the second and third phases for effectiveness and feasibility for a larger scale randomised controlled trial A sample of the participants will be interviewed pre and post the interventions for triangulation Hussein 2009 The final phase will be estimation of the rate of eligible participants willing to participate those who will drop out and those who will comply with the intervention to assist in designing a full randomised controlled trial A pragmatism epistemology will be assumed to allow a co-produced solution to the research question Setting Reablement service provided through ICT in the East Midlands of England due to the service facilitating discharges from hospitals but also experiencing recurrent admissions to its caseload Process Phase one Literature review A systematic approach of searching the literature through appropriate databases will be used to complete the literature review
The literature will be reviewed on the definition of loneliness and its appropriate measurement with respect to older adults The impact of loneliness on older adults and the interventions for tackling loneliness among older adults will also be reviewed Reablement being provided in facilitating and preventing hospital admissions will also be reviewed Phase two Service mapping exercise The public health departments of the county being studied will be contacted to get information on the available services for older adults in the community The local Age United Kingdom UK charity services Church of England churches Salvation Army churches Baptist churches libraries Caribbean Groups African groups Asian Groups Sikh Community will also be contacted for information on their available services These have been identified as stakeholders in older adult care in the county Therapy colleagues from the workplace will also be engaged for their input on available services within the county
Phase three
Co Designing with Patient and Public Interest PPI Group A Participatory Action Research PAR approach has been employed to engage a PPI group The PPI group was made of four older adults and were consulted on a one-to-one basis The PPI group helped in developing the questions to be asked in the semi structured interviews This is to allow a co-production of the questions for the semi structured interviews for the feasibility phase The Research Development Service RDS advocates the involvement of PPI group in health research as they would have a better experience of what is being researched Studies have shown that older adults wish to be involved in project development and delivery Interventions that involve users in design and implementation are more successful
Phase four
Feasibility Study Quantitative study Older adults about to be discharged from ICT independently faced with loneliness will be approached for participation Potential participants who show interest and give informed written consent will have the 11 item De Jong Gierveld loneliness scale administered to identify their loneliness risk This has been chosen over the 3 item University of California Los Angeles UCLA loneliness scale as it measures items specific to the research with respect to isolation and loneliness Those identified as at risk of loneliness score of at least 3 will be included in the study and those not at risk will no longer be included They will then be assigned randomly to the intervention groups using sealedenvelopecom The researcher who is also the chief investigator will have no access to the allocation sequence
Participants in the intervention one group will have a choice of the activities in the community they would like to attend Participants in the intervention two group will attend weekly online seated and standing exercises and discussions via TEAMS led by the researcher Participants physical and mental wellbeing will be measured with the EQ-5D-5L scale and demographic data of age sex ethnicity marital status and whether they have family will be taken Their frailty Index score will be noted pre and post the study These will help gain background information about the participants
Semi Structured Interviews Qualitative Study Semi structured interviews will be conducted with some randomly selected participants from both groups pre and post intervention The interviews are expected to last for up to one hour and will be recorded with a password protected audio recorder
Phase five
Estimating the participating rate The number of participants willing to take part those who will drop out comply with the interventions and sample size for the actual randomised controlled trial will be determined
Data analysis The interviews will be organised using NVivo 12 and analysed using thematic analysis to obtain the main themes Two-way ANOVA Analysis of Variance intervention one group verses intervention two group and pre-test verses post-test will be conducted using SPSS software to analyse data from the feasibility study Demographic data will also be analysed with the SPSS software The participating rate sample size as well as the standard deviation of the main outcome measure De Jong Gierveld Loneliness scale will be determined for the actual randomised controlled trial Hypothesis to be tested
1 There is no difference in the De Jong Gierveld loneliness scores between older adults who attended community activities for six months and those who attended online activities for six months
2 There is no difference in EQ 5L 5D scores between older adults who attended community activities for six months and those who attended online activities for six months
3 There is no difference in the frailty scores between older adults who attended community activities for six months and those who attended online activities for six months
Ethical Considerations Permission to complete the study will be sought from ICT managers Ethical approval will be sought from the Integrated Research Application System IRAS Health Research Authority HRA and the University of Northampton Ethics Committee
Potential Participants will be issued Participant Information Sheets and given seven days to read understand and ask questions The participant information sheet has been checked by two older adults for language and clarity
Informed written consent will be sought from participants prior to taking part in the study and they will be informed of their right to withdraw up to the data analysis stage through the participant information sheets without repercussions according to the declaration of Helsinki World Medical Association 2013 Participants who will be selected for the semi structured interviews will have to sign a second consent form specific to the interview
Participants data will be anonymised to remove identifiable information for their confidentiality The data will be stored securely in accordance with the General Data Protection Regulation GDPR 2018 in the University of Northamptons SharePoint
During the study if a participant lacks capacity they will no longer be included in the study from when they lack capacity Their data from when they had capacity will be included in the study and no further data will be collected from them Participants will be made aware of this through the participant information sheets The researcher coming from an African background where older adults are rarely left on their own had a culture shock knowing in the UK some older adults become at risk of loneliness Coupled with the fact that the researcher has worked in older adult reablement for over 12years and part of the current team under study the researcher is passionate about improving the quality of life of older adults and hence the motivation for the study Being mindful of these the researcher will approach the study with an enquiry mind to allow a co-produced outcome
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None