Effects of Self-Care for Older PErsons (SCOPE) on Functional and Physiological Measures: A Cluster Randomized Controlled Trial

Ted Kheng Siang Ng, David Bruce Matchar, Rehena Sultana, Angelique Chan, Ted Kheng Siang Ng, David Bruce Matchar, Rehena Sultana, Angelique Chan

Abstract

Background: Population aging poses unprecedented demands on the healthcare system. There is also a scarcity of evidence on self-care intervention to improve objective measures of morbidity and aging-associated functional and physiological measures in a low-income multi-ethnic population setting.

Methods: We conducted a cluster randomized controlled trial (ClinicalTrials.gov Identifier: NCT01672177) to examine the effects of the Self-Care for Older PErsons (SCOPE) program. We randomized 14 Senior Activity Centers and randomly selected older adults within these centers. Functional and physiological measurements were performed at baseline, 10-month, and 18-month periods. The primary outcome was a composite of three morbidity-specific measures, which include hemoglobin A1c (HbA1C), peak expiratory flow, and systolic blood pressure. Aging-associated functional and physiological measures were examined as secondary outcomes. Repeated-measure mixed models were employed to examine the effects of SCOPE on these measures.

Results: 378 community-dwelling older adults participated in either the treatment (n= 164) or the control arm (n = 214). The primary outcome was not significantly improved. For the secondary outcomes, SCOPE participants demonstrated slower oxygen desaturation at an 18-month period (p = 0.001), improved time to complete the chair-stand test (p < 0.001) at a 10-month period with the effect persisting at the 18-month period (p < 0.001). SCOPE participants also had significantly improved vitamin B12 levels at the 18-month period (p < 0.001), increased hemoglobin concentration (p < 0.001), decreased mean corpuscular volume (p = 0.001), and decreased creatinine (p = 0.002) at the 10-month period.

Conclusions: SCOPE did not improve morbidity-specific measures. However, it improved several aging-associated measures implicated in geriatric syndromes. This study highlights the potential of a self-care program in the prevention of geriatric syndromes in community-dwelling older adults, while emphasizing self-management to manage existing morbidities.

Keywords: community-based program; functional measures; physiological measures; randomized control trial; self-care.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
CONSORT 2010 Flow Diagram for SCOPE.

References

    1. Lorig K.R., Sobel D.S., Stewart A.L., Brown B.W., Jr., Bandura A., Ritter P., Gonzalez V.M., Laurent D.D., Holman H.R. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Med. Care. 1999;37:5–14. doi: 10.1097/00005650-199901000-00003.
    1. Lorig K.R., Ritter P., Stewart A.L., Sobel D.S., Brown B.W., Jr., Bandura A., Gonzalez V.M., Laurent D.D., Holman H.R. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med. Care. 2001;39:1217–1223. doi: 10.1097/00005650-200111000-00008.
    1. Jones H., Edwards L., Vallis T.M., Ruggiero L., Rossi S.R., Rossi J.S., Greene G., Prochaska J.O., Zinman B. Changes in diabetes self-care behaviors make a difference in glycemic control: The Diabetes Stages of Change (DiSC) study. Diabetes Care. 2003;26:732–737. doi: 10.2337/diacare.26.3.732.
    1. Norris S.L., Lau J., Smith S.J., Schmid C.H., Engelgau M.M. Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25:1159–1171. doi: 10.2337/diacare.25.7.1159.
    1. Iso H., Shimamoto T., Yokota K., Sankai T., Jacobs D.R., Komachi Y. Community-based education classes for hypertension control: A 1.5-year randomized controlled trial. Hypertension. 1996;27:968–974. doi: 10.1161/01.HYP.27.4.968.
    1. Chodosh J., Morton S.C., Mojica W., Maglione M., Suttorp M.J., Hilton L., Rhodes S., Shekelle P. Meta-analysis: Chronic disease self-management programs for older adults. Ann. Intern. Med. 2005;143:427–438. doi: 10.7326/0003-4819-143-6-200509200-00007.
    1. Worth H., Dhein Y. Does patient education modify behaviour in the management of COPD? Patient Educ. Couns. 2004;52:267–270. doi: 10.1016/S0738-3991(03)00101-0.
    1. Lorig K.R., Sobel D.S., Ritter P.L., Laurent D., Hobbs M. Effect of a self-management program on patients with chronic disease. Eff. Clin. Pract. ECP. 2001;4:256–262.
    1. Bandura A. Social Foundations of Thought and Action. Prentice Hall; Englewood Cliffs, NJ, USA: 1986.
    1. Huang O.S., Tay W.T., Tai E.S., Wang J.J., Saw S.-M., Jeganathan V.S., Sandar M., Wong T.Y. Lack of awareness amongst community patients with diabetes and diabetic retinopathy: The Singapore Malay eye study. Ann. Acad. Med. Singap. 2009;38:1048–1055.
    1. DeFriese G.H., Ory M.G. Self Care in Later Life: Research, Program, and Policy Issues. Springer Publishing Company; New York, NY, USA: 1998.
    1. Dale B., Söderhamn U., Söderhamn O. Self-care ability among home-dwelling older people in rural areas in southern Norway. Scand. J. Caring Sci. 2012;26:113–122. doi: 10.1111/j.1471-6712.2011.00917.x.
    1. Badzek L., Hines S.C., Moss A.H. Inadequate self-care knowledge among elderly hemodialysis patients: Assessing its prevalence and potential causes. Nephrol. Nurs. J. 1998;25:293.
    1. Rockwell J.M., Riegel B. Predictors of self-care in persons with heart failure. Heart Lung. 2001;30:18–25. doi: 10.1067/mhl.2001.112503.
    1. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol. Rev. 1977;84:191. doi: 10.1037/0033-295X.84.2.191.
    1. Bandura A. Self-efficacy mechanism in human agency. Am. Psychol. 1982;37:122. doi: 10.1037/0003-066X.37.2.122.
    1. Bandura A., Freeman W., Lightsey R. Self-Efficacy: The Exercise of Control. Springer; New York, NY, USA: 1999.
    1. Israel B.A., Checkoway B., Schulz A., Zimmerman M. Health education and community empowerment: Conceptualizing and measuring perceptions of individual, organizational, and community control. Health Educ. Q. 1994;21:149–170. doi: 10.1177/109019819402100203.
    1. Chan A., Matchar D.B., Tsao M.A., Harding S., Chiu C.-T., Tay B., Raman P., Pietryla Z., Klein M.K., Haldane V.E. Self-Care for Older People (SCOPE): A cluster randomized controlled trial of self-care training and health outcomes in low-income elderly in Singapore. Contemp. Clin. Trials. 2015;41:313–324. doi: 10.1016/j.cct.2015.01.001.
    1. International Expert Committee International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327–1334. doi: 10.2337/dc09-9033.
    1. WHO . Use of Glycated Haemoglobin (HbA1c) in Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation. WHO; Geneva, Switzerland: 2011.
    1. Jackson H., Hubbard R. Detecting chronic obstructive pulmonary disease using peak flow rate: Cross sectional survey. BMJ. 2003;327:653–654. doi: 10.1136/bmj.327.7416.653.
    1. National Institutes of Health . Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health; Bethesda, MD, USA: 1998. Guidelines for the Diagnosis and Management of Asthma.
    1. Malhotra R., Malhotra C., Chan A., Østbye T. Life-course socioeconomic status and obesity among older Singaporean Chinese men and women. J. Gerontol. Ser. B Psychol. Sci. Soc. Sci. 2012;68:117–127. doi: 10.1093/geronb/gbs102.
    1. Health SMo . National Health Survey 2004. Ministry of Health of Singapore; Singapore: 2005.
    1. Donner A., Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. Wiley; Hoboken, NJ, USA: 2010. Sample size estimation for cluster randomization designs.
    1. Chen S.-Y., Feng Z., Yi X. A general introduction to adjustment for multiple comparisons. J. Thorac. Dis. 2017;9:1725. doi: 10.21037/jtd.2017.05.34.
    1. Sedgwick P. Multiple hypothesis testing and Bonferroni’s correction. Bmj. 2014;349:g6284. doi: 10.1136/bmj.g6284.
    1. Althouse A.D. Adjust for multiple comparisons? It’s not that simple. Ann. Thorac. Surg. 2016;101:1644–1645. doi: 10.1016/j.athoracsur.2015.11.024.
    1. Verbeke G., Molenberghs G. Linear Mixed Models for Longitudinal Data. Springer Science & Business Media; Medford, MA, USA: 2009.
    1. Katz S. Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living. J. Am. Geriatr. Soc. 1983;31:721–727. doi: 10.1111/j.1532-5415.1983.tb03391.x.
    1. Panagiotakos D., Kourlaba G., Zeimbekis A., Toutouzas P., Polychronopoulos E. The J-shape association of alcohol consumption on blood pressure levels, in elderly people from Mediterranean Islands (MEDIS epidemiological study) J. Hum. Hypertens. 2007;21:585. doi: 10.1038/sj.jhh.1002187.
    1. Lloyd-Sherlock P., Beard J., Minicuci N., Ebrahim S., Chatterji S. Hypertension among older adults in low-and middle-income countries: Prevalence, awareness and control. Int. J. Epidemiol. 2014;43:116–128. doi: 10.1093/ije/dyt215.
    1. Lorig K., Ritter P.L., Plant K. A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis Care Res. Off. J. Am. Coll. Rheumatol. 2005;53:950–957. doi: 10.1002/art.21604.
    1. Breitenstein S.M., Gross D., Garvey C.A., Hill C., Fogg L., Resnick B. Implementation fidelity in community-based interventions. Res. Nurs. Health. 2010;33:164–173. doi: 10.1002/nur.20373.
    1. Bohannon R.W. Sit-to-stand test for measuring performance of lower extremity muscles. Percept. Motor Skills. 1995;80:163–166. doi: 10.2466/pms.1995.80.1.163.
    1. Jones C.J., Rikli R.E., Beam W.C. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res. Q. Exerc. Sport. 1999;70:113–119. doi: 10.1080/02701367.1999.10608028.
    1. Moreland J.D., Richardson J.A., Goldsmith C.H., Clase C.M. Muscle weakness and falls in older adults: A systematic review and meta-analysis. J. Am. Geriatr. Soc. 2004;52:1121–1129. doi: 10.1111/j.1532-5415.2004.52310.x.
    1. Al-Thihli K., Sinclair G., Sirrs S., Mezei M., Nelson J., Vallance H. Performance of serum and dried blood spot acylcarnitine profiles for detection of fatty acid β-oxidation disorders in adult patients with rhabdomyolysis. J. Inherit. Metab. Dis. 2014;37:207–213. doi: 10.1007/s10545-012-9578-7.
    1. Okamoto N., Nakatani T., Morita N., Saeki K., Kurumatani N. Home-based walking improves cardiopulmonary function and health-related QOL in community-dwelling adults. Int. J. Sports Med. 2007;28:1040–1045. doi: 10.1055/s-2007-965073.
    1. Brubaker P.H., Kitzman D.W. Chronotropic incompetence: Causes, consequences, and management. Circulation. 2011;123:1010–1020. doi: 10.1161/CIRCULATIONAHA.110.940577.
    1. Hollmann W., Strüder H.K., Tagarakis C.V., King G. Physical activity and the elderly. Eur. J. Cardiovasc. Prev. Rehabil. 2007;14:730–739. doi: 10.1097/HJR.0b013e32828622f9.
    1. Son S.M., Kim M.J. The effect of nutrition education program for various chronic disease in elderly visiting public health center. Korean J. Community Nutr. 2001;6:668–677.
    1. Baik H., Russell R. Vitamin B12 deficiency in the elderly. Annu. Rev. Nutr. 1999;19:357–377. doi: 10.1146/annurev.nutr.19.1.357.
    1. Kwok T., Cheng G., Woo J., Lai W., Pang C. Independent effect of vitamin B12 deficiency on hematological status in older Chinese vegetarian women. Am. J. Hematol. 2002;70:186–190. doi: 10.1002/ajh.10134.
    1. Rose M.A., Arenson C., Harrod P., Salkey R., Santana A., Diamond J. Evaluation of the chronic disease self-management program with low-income, urban, African American older adults. J. Community Health Nurs. 2008;25:193–202. doi: 10.1080/07370010802421178.
    1. Collard C., Robinson-Dooley V., Patrick F., Farabaugh K. Efficacy of Chronic Disease Self-Management among Low-Income Black Males with Behavioral Health Disorders: Pilot Study. J. Ga. Public Health Assoc. 2016;6:4.
    1. Jerant A., Moore-Hill M., Franks P. Home-based, peer-led chronic illness self-management training: Findings from a 1-year randomized controlled trial. Ann. Fam. Med. 2009;7:319–327. doi: 10.1370/afm.996.

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