The psychological impact of a nurse-led proactive self-care program on independent, non-frail community-dwelling older adults : a randomized controlled trial

Abstract

Background: Poor mental health is common later in life and is a crucial factor in determining older adults’ ability to live independently in the community. Existing nurse-led proactive self-care programs for older adults focus on physical health, since many are living with chronic diseases. Little is known about their effectiveness on the psychological outcomes of independent, non-frail community-dwelling older adults. Aim: The aim of this study was to examine the impact of a nurse-led proactive self-care program with a health-social partnership model for community-dwelling older adults on depressive symptoms, life satis- faction, and the mental component of health-related quality of life. Design and Methods: This was a single-blinded, randomized controlled trial. Adults aged 60 or over who lived within the service areas and scored ≥18 in the Mini-Mental Status Examination were included. Data were collected using questionnaires pre- (T1), post- (T2), and three month after the intervention (T3). The program provided a comprehensive assessment, health and self-management information, and empowerment, and promoted the accessibility of community services by building a health-social partner- ship network in the community. Generalized Estimating Equation was used to calculate the group, time, and interaction effects. Intention-to-treat was employed as the primary analysis in this study. Results: Of the 843 potential community-dwelling older adults who were assessed for eligibility, 457 el- igible participants were randomized into the intervention ( n = 230) or control group ( n = 227). Among them, 175 (76.0%) participants in the intervention group and 190 (83.7%) participants in the control group completed data collection at T3, 6 months after T2 at the completion of the program. The results showed a significant time effect between T1 and T2 (Wald χ2 = 25.7, p < .001) and T1 and T3 (Wald χ2 = 7.40, p = .007) in terms of the presence of depressive symptoms. Conclusions: Interprofessional care addressing health and social needs improves the depressive symptoms among older adults dwelling in the community.