Effects of Participatory and Physical Life Goals in a Preventive Care Program for Frail Community-Dwelling Older People: A Retrospective Cohort Study

PURPOSE: A previous study (Yuri, Takabatake, Nishikawa, Oka, & Fujiwara, 2016) reported that a 3-mo care prevention program (CPP) helped decrease frailty and improve quality of life (QOL), and efficacy increased with the addition of life goal setting. However, differentiation was not made between participatory and physical life goals. We aimed to clarify the influence of life goals related to activities and participation on care prevention outcomes and QOL in a CPP for community-dwelling frail older people.

DESIGN AND METHOD: We performed a retrospective cohort study using a previously described cohort of all participants admitted to a CPP between October 2009 and March 2011 in Izumi, Osaka, Japan. There were 89 participants age 65 yr and older living in the community in Izumi. All were assessed as frail per the Japanese Ministry of Health, Labour and Welfare’s Kihon Checklist (KC; Arai & Satake, 2015). All were participating in a CPP that included physical exercise classes and oral care and nutrition education given once per week (120 min) for 3 mo. Three occupational therapists with master’s-level education and 15 yr of experience examined all records and data, including care plans, to determine sense of meaning or living conditions for each individual. According to long-term life goals (LG) and 3-mo short-term goals (SG), they classified participants into an Activity and Participation (AP) group and a Body Functions and Structures (BS) group using the International Classification of Functioning, Disability and Health (World Health Organization, 2001). The care prevention outcome was decreased frailty per the KC for assessment of frailty, analyzed using chi-square. QOL and physical functions were analyzed using two-way analysis of variance.

RESULTS: There were 68 (76.4%) participants in the AP group (55 [80.9%] female; M age = 75.43, SD = 6.35) and 21 (23.6%) participants in the BS group (16 [76.2%] female; M age = 75.95, SD = 6.18). There were no significant differences between the two groups for any variables. The AP group was scored 40 (58.8%) of the possible decreased frailty points at the 3-mo interval. In contrast, the BS group was scored 6 (28.6%), a significant difference (p = .015). QOL analysis showed that the AP group scored 3.15 (SD = 0.76) at baseline and 3.63 (SD = 0.77) at 3 mo. The BS group scores were 3.33 (SD = 0.97) at baseline and 3.24 (SD = 1.00) at 3 mo. The differences yielded a significant Time × Group interaction effect (p = .013). There was no significant Time × Group interaction for physical function scores (grip strength and Timed Up and Go test).

Regarding SG and LG analysis, both BS (BSBS) groups’ participants were the same as the BS group. There were 25 (36.8%) participants in both AP (APAP) groups (22 [71.9%] female; M age = 77.20, SD = 7.14). There were 43 (63.2%) participants in the AP group of the LG and BS group for SG (APBS; 49 [76.6%] female; M age = 74.91, SD = 5.85). We compared the APAP and APSB groups and found no significant differences for any variables or in decreased frailty, QOL, and physical function.

DISCUSSION AND CONCLUSION: This study showed that long-term life goals related to activity and participation had a more beneficial effect on care prevention outcomes and QOL than life goals related to body functions and structures in preventive care of frail older people; however, there was no significant difference in physical function. These findings indicate the importance of setting long-term life goals. There was no significant difference between the APAP and APBS groups. Regardless of whether an individual’s short-term goals relate to body functions and structures or to activities and participation, it is important to establish a sense of meaning and favorable living conditions for frail older people.

References

Arai, H., & Satake, S. (2015). English translation of the Kihon Checklist. Japan Geriatrics Society, 15, 518–519. https://doi.org/10.1111/ggi.12397

World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.

Yuri, Y., Takabatake, S., Nishikawa, T., Oka, M., & Fujiwara, T. (2016). The effects of a life goal-setting technique in a preventive care program for frail community-dwelling older people: A cluster nonrandomized controlled trial. BMC Geriatrics, 16, 101. https://doi.org/10.1186/s12877-016-0277-3