Effectiveness and cost effectiveness review

99 Pages·2008·0.58 MB·English

by  Gill Windle

PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Public health interventions to promote
mental well-being in people aged 65 and over.
A systematic review of effectiveness and cost effectiveness.

Evidence Tables

Gill Windle1, Pat Linck2, Rhodri Morgan1, Dyfrig Hughes2, Vanessa Burholt1, Carla Reeves1, Seow Tien Yeo2, Bob Woods3,
Rhiannon Tudor Edwards2, Ian Russell4.

1 Centre for Social Policy Research & Development, Institute of Medical & Social Care Research, University of Wales
Bangor.
2 Centre for Economics & Policy in Health, Institute of Medical & Social Care Research, University of Wales Bangor.
3 Professor of Clinical Psychology of the Elderly, Institute of Medical & Social Care Research, University of Wales Bangor.
4 Professor of Public Health, Institute of Medical & Social Care Research, University of Wales Bangor.
1
PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Intervention and population details Analyses Results Comments

Annesi (2004a) The intervention is a moderate exercise Baseline comparability: ANOVA indicated no significant mean difference between 1 The women had
programme. Each participant was individually Ethnic and socioeconomic make-up groups on the POMS dimension of tension (F 2,93 = 1.23, already joined the
CBAS trained by the exercise leader in the study's were similar. No other comparisons ns), depression (F 2,93 = 0.58, ns) or fatigue (F 2,93 = community facility, and so
(quality rating -) protocol. 1 set of between 8 and 11 weight are made at baseline. 1.04, ns) scores at week 1. were motivated to
stack machines for 8 to 12 reps (to muscle undertake exercise.
Objective: fatigue) on 3 non-consecutive days per week. Attrition ANCOVA with scores at week 1 as the covariate revealed
What are the mood 20 -30 minutes of cardiovascular exercise on Number of participants completing a significant group difference in mood changes over 10 2 Strange choice of
changes in two age self-selected machine. study: Not reported. wks. control group – between 2
groups of women Tension Depression Vigour Fatigue very different intervention
starting exercise Providers/Deliverers: Exercise leader. Reasons for non-completion: Control 6.7 5.9 15.4 7.0 groups
programmes? Not reported. Week 1 (3.9) (5.2) (5.8) (3.4)
Length: Not reported. Week 10 7.4 6.4 15.8 7.5 3 Problem exacerbated
Recruitment: Process details (3.5) (4.4) (5.9) (4.4) by lack of power
Total sampling frame Duration: 10 weeks. Data collection methods: Self- Younger 7.7 6.1 16.8 7.8 calculation
and initial refusals report. Week 1 (3.8) (4.9) (5.6) (5.7)
not reported. 96 Intensity: Moderate. Week 10 3.8 2.3 20.6 2.9
women who initiated Statistical methods: (2.8) (3.2) (4.2) (2.8)
membership in the Comparator: Did not begin an exercise ANOVA, ANCOVA. Scheffe follow- Applicability:
Older 5.6 4.0 14.2 5.5
community wellness programme before termination of this study. up tests. Week 1 (4.0) (3.7) (6.7) (4.1) The intervention has face
centre and gave validity and could be
Week 10 3.3 2.6 15.3 4.2
informed consent Population details Unit of analysis: Individual undertaken in UK.

were the study Inclusion: Female between the ages of 21 and However the findings
F 6.97, 18.72 4.31 15.68
sample. The control 45 (younger exercise), 55 and 80 (older Time to follow up: Post-intervention 2,93 might generalise only to
p<.01 (p<.01) (p<.05) (p<.01)
group were women exercise) and 21 and 80 (control). No regular (10 weeks). self-selectors for exercise

who also initiated exercise in the previous 6 months. Apparently
Scheffe follow-up tests indicated that both the younger and
membership, but healthy based on health risk appraisal. POMS Mental well-being measure(s):
older exercise groups improved significantly more than the
indicated that they score at intake within +/- 1 SD of the sex- Profile of Mood States (POMS).
no-exercise control group on all scales (tension,
were not ready to adjusted mean previously reported.
depression, vigour and fatigue – no data reported).
begin an exercise Power calculation:

programme. Exclusion: Not reported Not reported.
No significant differences were found between the two
Unit of allocation: Individual
exercise groups on changes over 10 wk. Scores at Week
Setting:
10 significantly differed between the younger and older
Community wellness Total: n = 96
treatment groups on the Vigour scale only (t62 = 3.64, p<
centre Intervention: n = 64
.01).
Comparator: n = 32.

Country: Gender: 100% women
Post hoc testing indicated that, when treatment groups’
South-eastern USA Mean age (range):
mood scores were aggregated, the amount of
Younger (23-45 years) M = 32.6, SD = 7.1; older
improvement over 10 wk was significantly correlated with
Funding Source: ( 55-79 years) M = 63.4, SD = 6.5; control (25-
Week 1 scores on Tension (r = - .63, p<.01), Depression
Not reported 73 years) M = 48.4, SD = 15.7. 62
(r = -.75, p<.01), and Fatigue (r = -.74, p<.01), but not
62 62
Vigour (r = -.22, ns)
SES: Primarily middle class participants 62

Adverse effects: None reported

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PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Intervention and population details Analyses Results Comments
Annesi (2004 b). Baseline comparability: The mean change on the POMS
The intervention is a 10 week, 30 session exercise Not applicable, no control group. dimension of depression was -2.1, SD The study provides weak
Single group before and programme of moderate cardiovascular, resistance Attrition = 4.9 and on total mood disturbance evidence that an exercise
after [UBAS] and stretching exercises. Number of participants completing was -5.3, SD = 16.4 (it is unclear from programme reduces
(quality rating -) study: Not reported. the paper whether this is significant. . depression scores
Providers/Deliverers: Not reported. A weakness was that
Objective: variability’s in responses (SD)
What is the relation of Length: Not reported. Reasons for non-completion: were two to three times the
body fat to depression Not reported. mean change in scores. Also
and overall mood changes Duration: 10 weeks. the authors report that
over a 10-week course of Process details distributions of change scores
moderate exercise in Intensity: Moderate intensity (3 sessions per week). Data collection methods: Adverse effects: None reported. are usually skewed, making
formerly sedentary older Self-report. statistical interpretation
women? Comparator: No comparator. problematic.
Statistical methods:
Recruitment: Population details Mean change, and non-parametric
Participants enrolled in a Inclusion: Sedentary older women analyses using a high/low median split. This is a very short article and
supervised exercise Exclusion: Not reported lacks sufficiently detailed
programme. No details of Unit of allocation: Individual Unit of analysis: information on many counts.
how they were recruited Individual
or the number of the initial Total: N = 62.
sampling frame are Intervention: N = 62. Time to follow up:
reported. Comparator: No comparator. Post intervention (at 10 weeks).
Gender: 100% female. Applicability:
Setting: Mean age (range): Mean = 65.4, SD = 8.4. Mental well-being measure(s):
Not reported, although Profile of Mood States (POMS) Finding is probably applicable
paper would indicate a SES: Not reported. Power calculation: to UK setting but little
group/community setting. A power analysis indicated enough information given about the the
participants to detect a medium effect at components of this exercise
Country: the recommended power of .80. programme.
Not reported (author is
affiliated to American
institution).

Funding Source:
Not reported.

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PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Intervention and population details Analyses Results Comments

Annesi et al. (2004a) 10 weeks of resistance training three times per week Baseline comparability: For the associative group there were The authors have conducted a
in a specifically designed room. 1 set of 8 to 12 reps Yes on age, weight, height, resting heart no significant 10 week changes for large number of t-tests,
Experimental 2 condition of 12 exercises per session. Associative condition - 5 rate, percent body fat, or strength. the POMS dimensions of depression, increasing the possibility of
before and after study to 8 verbal cues related to their exercises to tension, fatigue, anger, confusion or Type 1 errors. The authors do
[variant of UBAS] maximise there attentional focus on the task. Attrition vigour. not acknowledge the study
(quality rating -) Socialising was kept minimal and distractors (e.g. Number of participants completing limitations.
music) were excluded. The dissociation group study: Not reported, but it would appear For the dissociation group, significant
Objective: included casual conversation as well as music. There that all the participants completed. 10 week changes (reductions) were However the finding that
Is 10 weeks of weight was minimal use of physically related verbal cues. found for the dimension of depression and tension were
training more effective in Attentional focus to external stimuli such as imagery Reasons for non-completion: depression (T1 m=6.40, sd=2.73, T2 reduced only in the dissociation
improving mental well- and music (as opposed to physiological sensation) Not reported. m=2.73 sd=3.6; t [15] =-2.64, p<.05, group is interesting..
being in older women was encouraged. d=.64)
when attention is focused Process details tension (T1 m=7.67, sd=4.65, T2
on task or elsewhere? Providers/Deliverers: Certified exercise Data collection methods: Self-report. m=5.27, sd=3.79; t [15] =-2.77, p<.05,
professionals. d=-.57).
Recruitment: Statistical methods: ANOVA and Applicability:
Women who registered for Length: Not reported. independent t tests. There were no significant changes The intervention has similarities
a 10 week strength Duration: 10 weeks. over time for fatigue, anger, confusion with programmes in the UK and
training programme were Intensity: 3 x per week. Unit of analysis: Individual or vigour. is likely to be applicable to
recruited into the study. similar populations and
Each individual agreed to Comparator: There are two conditions of the Unit of allocation: Individual settings.
participate in the study. intervention (associative and dissociative). No control
There are no details as to group. Time to follow up: Adverse effects:
whether anyone declined Post intervention (10 weeks) None reported
to participate before Population details
allocation, or whether Inclusion: Minimum age of 50, no regular exercise Mental well-being measure(s):
anyone dropped out in the last 6 months, apparently healthy based on a POMS
before completion. medical history questionnaire.
Power calculation: Not presented
Setting: Exclusion: Not reported.
YMCA, in a specifically
designed room. Unit of allocation: Individual.

Country: Total: n = 39.
Northeast USA Intervention: n = 23.
Comparator: n = 16.
Funding Source:
Not reported Gender: 100 % female.

Mean age (range): 50-79 (M = 65.3, SD = 7.9).

SES: Not reported.
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PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Intervention and population details Analyses Results Comments

Annesi et al .(2004b) 10 weeks of combined resistance and cardiovascular Baseline comparability: N/A, only 1 Significant improvements were found The study focus is on a small
exercise (order alternated each session) with 2 group. for: volunteer group with very
Before and after study sessions per week. Approx 20 minutes of total mood disturbance (pre m=6.9, specific characteristics of
(no control group) [UBAS] cardiovascular exercise per session at rate of Attrition sd=15.2, post m=2.2 sd=14.6; d=.32) ethnicity and socio-economic
(quality rating -) perceived exertion of 4 or 5. 11 resistance exercises. Number of participants completing and the dimensions of status.
study: n = 17 (100%). depression (pre m=2.8 sd=3.1, post
Objective: Providers/Deliverers: m=1.8, sd=1.8 d=.55) and The very small sample size and
What is the effect of 10 Exercise professionals and registered dieticians. Reasons for non-completion: Not fatigue (pre m=4.5, sd=3.8, post weak study design severely
weeks of combined applicable. m=3.1, sd=3.6; d=.37). limits the usefulness of the
strength and Length: study. At best the study
cardiovascular exercise Approx 20 minutes of cardiovascular exercise per Process details provides some weak evidence
on both physiological and session. Data collection methods: Self-report. Adverse effects: that exercise has a positive
psychological measures? None reported effect on mood disturbance,
Duration: 10 weeks Statistical methods: Descriptive depression and fatigue.
Recruitment: Intensity: Cardiovascular exercise at RPE 4 or 5 = statistics - means and standard deviations.
The participants moderate intensity. Applicability:
volunteered. There are no Unit of analysis: Individual. The intervention has
more details on Comparator: No comparator. similarities with programmes in
recruitment. Unit of allocation: Individual. the UK and is likely to be
Population details applicable to similar
Setting: Inclusion: Minimum age of 60 years; no regular Time to follow up: Two or three days populations and settings
YMCA. exercise within the previous year; no after final exercise session.
contraindications for exercise; no use of blood
Country: pressure medication. Mental well-being measure(s):
South-east USA. Profile of Mood States (POMS) .
Exclusion: None reported.
Funding Source: Unit of allocation: Individual. Power calculation: None reported.
Not reported.
Total: n = 17 participants.
Intervention: n = 17.
Comparator: None
Gender: 100% female
Mean age (range): mean age = 66.8 years (range
60-75).

SES: Middle socioeconomic status.

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PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Review Parameters Review Parameters Results Comments

Arent et al. (2000). Criteria for Inclusion of studies: Synthesis: The overall mean effect size for mood based on a total of 51 The results are consistent with
Examined the effect of exercise on some construct of Separate analyses effect sizes was 0.34 (p<.05) indicating that compared to a the conclusions of a previous
Meta-analysis [MA] mood in older adults. At least one of the following: of effect size were control group exercise improves mood (10 effect sizes were narrative and two meta-analytic
(quality rating +) The mean age of the study sample was >65; there conducted for each excluded as they were not comparable at baseline). reviews examining the effects
must have been at least one exercising group with a of the three of exercise. The examination of
Objective: mean age of >65; or if mean ages were not provided, categories of The largest effect size for frequency was related to the moderator variables is helpful
What are the effects of the age range of the participants must have had a studies. Tests for studies in which participants exercised </= 3 days a week, as it provides some insight into
exercise on mood in older lower bound of at least 60 years. All English homogeneity were which was significantly different from 0 (ES=0.69, sd=0.45). potential mechanisms driving
adults? language studies. conducted. It was also significant from the average effect size the exercise-mood relationship.
associated with exercising >/= 3 days a week.
Databases Searched: Exclusion: Details of The authors state that there is
PsycLit, ERIC, Insufficient data to calculate Effect sizes. Heterogeneity: The largest average effect for time per session was a lack of studies examining the
SPORTDiscus, Yes there is associated with exercise bouts that were self selected and effects of exercise on positive
Dissertation abstracts, Number of studies included: heterogeneity variable in duration (ES=0.86, sd=0.50). Exercise that affect in the elderly. The
healthStar, Medline. 32 studies. Experimental vs. control group across studies. lasted >45mins was also significant (ES=0.36, sd=0.40). research focussed on reducing
Handsearches of comparisons n=61; pre-post test comparisons n=83; bad mood rather than
Psychological Abstracts correlational n=24. All levels of weeks of participation were associated with increasing good mood. They
and Social Science effect sizes significantly greater than 0; 1-6 weeks ES=0.48, state that strength training is a
Citation Index, and other Data Extraction: sd=0.59, 7-12 weeks ES=0.45, sd=0.39, >12 weeks viable form of exercise for this
relevant journals in the Design and descriptive characteristics, participant ES=0.19, sd=0.27. population, but needs
areas of gerontology, characteristics, exercise characteristics and mood evaluation in well-developed
psychology and exercise assessment characteristics. The average effect associated with low intensity exercise psychological studies.
science. (ES=0.58, sd=0.29) was significantly greater than that
The included studies were coded for a number of associated with either medium (ES=0.26, sd=0.40) or high Applicability:
Years: characteristics based on a priori decisions regarding intensities (ES=0.29, sd=0.46). This is a meta-analysis of
Before 1998. potential moderator variables for the exercise-mood international research and the
relationship in the elderly. These characteristics Cardiovascular exercise (ES=0.26, sd=0.46), resistance results are likely to be
Funding Source: were classified as design and descriptive training (0.38, sd=0.43) and a combination of both (0.49, applicable to the UK.
Not reported. characteristics, participant characteristics, exercise sd=0.43) were all associated with effects significantly
characteristics, and mood assessment greater than 0.
characteristics. Separate forms were used for each
of the three databases. Moderator variables were Resistance training produced greater effects than all other
identified through the previous related meta-analyses types of activity (ES=0.80, sd=0.24. High (ES=0.29,
and suggestions made by authors in the gerontology sd=0.45), medium (ES=0.38, sd=0.45) and low (ES=0.34,
literature. The primary author coded all studies. sd=0.31) intensities were all significantly different from zero
Potential coder drift was assessed by selecting 10 of but not from each other.
the coded studies at random and re-coding them. A Exercise was associated with improved mood across all
per-case agreement rate was calculated or each levels of initial health status, not just those in poorest health
study. An agreement rate of .90 was required to be (health not reported ES=0.35, sd=0.40; healthy and active
considered acceptable. ES=0.27, sd=0.38; healthy and sedentary ES=0.19,
sd=0.33; mixed ES=0.44, sd=0.46).

Studies that reported cardiovascular fitness increase were
associated with significantly larger effect sizes (ES=0.48.
sd=0.45) than those that reported no fitness increase
(ES=0.16, sd=0.29) suggesting physiological improvement
might moderate mood improvement.

Averse Effects: None reported.
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PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Intervention and population details Analyses Results Comments
Barnes & Bennett (1998).
The intervention aimed to enable frail older people to Baseline comparability: The analysis reports three key The paper does not describe
Qualitative study discuss their experiences of growing older and of Only intervention group themes: personal development for the fully the analysis process and
(quality rating –) using health and social care services (but not to members, enhanced self-esteem and the ethical procedures
provide feedback on specific services) to influence Attrition the empowerment of panel members adequately.
Objective: service planning and provision. 7 panels were Number of participants completing and reduced social isolation through
Evaluation of the Users established. Discussions centred around growing study: 21out of 62. the opportunity for social contact and
Panel Project, which aims older, and experiences of health and social care sharing experiences. Participants Applicability:
to enable frail older services. For example when the issue of home carers Reasons for non-completion: reported that they had more courage The intervention is likely to be
people who are unable to arose project workers invited panel members to set 8 died, 6 because of illness or admission to 'voice their opinion'. However applicable to similar
leave their homes to out their priorities for tasks to be undertaken by home to residential care. 7 for other reasons. 34 participants were less certain of their populations or settings in the
discuss their experiences carers. These priorities were then compared with could not make one or more panel impact on services than the benefits UK as panel user groups are
of growing older and of those of the social work department. Key questions meetings. of being involved in the panels. already run across the UK in
using health and social were developed to be put to social care managers. some local authorities.
care services, and to use Process details Adverse effects:
the outcomes of such Providers/Deliverers: Data collection methods: Some participants felt that the panels
discussion to influence Age Concern Scotland. Semi-structured and structured interviews. did not have a practical effect on
service planning and service provision or development.
provision. Length: Not reported. Statistical methods: Some also said that they did not like
Duration: 3 year project. Qualitative interviews. to discuss their problems and that it
Recruitment: Intensity: monthly. could upset them.
Project workers Unit of analysis: Individual.
approached home carers, Comparator: No comparator.
social workers, district Unit of allocation: Individual.
nurses, health visitors, Population details
churches and voluntary Inclusion: Frail older people who were typical of
groups asking for those who use health and social care services. Time to follow up: 3 interviews at 10
recommendations for month intervals.
people who may Exclusion: Dementia diagnosis.
participate. 90 people
were nominated and 62 Unit of allocation: Individual. Mental well-being measure(s):
agreed to participate. Interview comments.
Total: N=62.
Setting: Intervention: Not reported Sample size calculation: Not applicable
The panels met in a Comparator: Not reported
variety of venues that
were appropriate for Gender: 54 out of 62 were women.
people with different
physical impairments. Mean age (range):
Transport was provided. 67-93 years, average 82. 35% were aged 86-90 yrs.
Country:
Fife, Scotland. SES: Not reported.

Funding Source: Not
reported.
7
PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Intervention and population details Analyses Results Comments
Baseline comparability:
Barnicle & Midden, The intervention is a horticulture activity programme. No significant differences were found There were no significant differences The authors suggest that
(2003). It took place indoors where the residents could sit. between the control group and the (F=0.70, p=.41) on the pre-test ABS careful consideration was given
Three tiered plant stands were constructed out of horticulture group on any of the score for the intervention group in choosing two facilities that
CBAS (quality rating –) PVC pipe to hold the plant material after each demographic data (gender, race, marital (m=5.42) and control group (m=4.29). had similar living environments
horticulture activity session. Grow lights were located status, religion, age, years residing in and older adult populations.
Objective: on each tier. The plant stands were placed in an facility, gardening experience, type of care There were no significant difference in
What effect does a 7 accessible area where residents could have passive provided, avowed happiness, subjective the control ABS score pre-test Nevertheless the fall in the ABS
week horticulture and active contact with the plants throughout the health and pre-test psychological well- (m=4.29) and post-test (m=3.00) or in controls could be the result
programme have on the week. being score. for the intervention group pre test of ‘resentful demoralisation’
psychological well-being (m=5.42) and post test (m=7.61).
of older people in a long- Providers/Deliverers: Author of the paper. Attrition The authors suggest that future
term care facility? Number of participants completing Comparison of mean ABS score research could assess if the
Length: 1 hour. study: Not stated between groups over the pre-test beneficial effects of a
Recruitment: Duration: 7 weeks. post-test period found that the horticulture programme last
Residents volunteered to Intensity: 1 x week. Reasons for non-completion: intervention group had a significantly over a longer time period within
be part of the horticulture Not stated better ABS score (m=7.61) as this population. Future research
activity programme. 31 Comparator: No intervention (wait list). compared to the control group could also include another
participants selected from Process details (m=3.00; F=6.78, p=.01). therapy as a comparison group.
one residential facility Population details Data collection methods:
served as the Inclusion: None reported. Primarily self report. The scale was No standard deviations or sample size Applicability:
experimental group, 31 administered verbally to any of the of groups analysed are reported. Simple horticultural activity
from another residential Exclusion: Not reported participants who could not fill out the programmes could be
facility served as the Unit of allocation: Individual. assessment on their own. (*No figures Analysis of covariance is better undertaken in similar
controls. The control reported for how many were assisted). method of analysing data with populations and settings in the
group were told that the Total: N=62. base;line imbalances UK.
horticultural programme Intervention: n = 31. Statistical methods:
would begin for them in 7 Comparator: n = 31. 2-way ANOVA. Adverse effects:
weeks. None reported
Gender: 28 females and 3 males in both the control Unit of analysis: Individual.
Setting: and experimental group (n=62). Unit of allocation: Individual.
Indoors in the care facility
at a table where residents Mean age (range): Time to follow up:
could sit. Control m=87.71, experimental m=85.97. Immediately post test.

Country: SES: none presented Mental well-being measure(s):
St. Louis, USA Affect Balance Scale (ABS).

Funding Source: Power calculation:
Not reported Not presented.
8
PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Intervention and population details Analyses Results Comments
Billipp. (2001) Participants assigned to computer groups were given Baseline comparability: A t-test comparing the difference of The size of the
a computer terminal for the duration of the study. No evidence presented regarding the balance of mean computer hours for lower sample in each of
Randomised controlled Computer group I: Participants were limited to demographic characteristics at baseline. Pre-study esteem scores (improved self-esteem) the groups under
trial introductory, first-day computer training during the test for equality of means indicated there were no versus higher self-esteem scores examination is very
(quality rating -) first weekly nurse visit. Computer group II: significantly different pairs between groups in self- (decreased self-esteem) at the end of small (n=10). This
Participants received weekly nurse computer training esteem at the onset of the study (Group 1 vs. IV: t=- the study was not significant (p=.065). severely limits the
Objective: throughout the study period. Computer Group III: First 0.19, p=0.85; Groups II vs. IV: t=-1.44, p=0.83; findings of the study.
It was hypothesized that: week computer training included the participant and a Groups III vs. IV: t=--0.23, p=0.82). Good Noting that a negative score on the There is also a risk
1. The amount of time participant's significant other who then took over the reproducibility was indicated by a weighted Kappa Rosenberg Self-Esteem Scale is in of bias in the study.
spent interacting on a nurse's role of computer trainer after the first visit. statistic 0.53 with a 95% CI 0.31 to 0.75. the direction of improved self-esteem,
computer network would the -0.08 correlation between Applicability:
be positively correlated Providers/Deliverers: Attrition computer time and improved self- The intervention is
with change in self- Registered nurses specialising in geriatrics. Not stated – analysis was for four groups of 10. esteem indicated a positive but likely to be
esteem. 2. Interactive insignificant association (p=0.65). applicable across a
computer use would be Length: Reasons for non-completion broad range of
associated with a change The length of time spent in participants’ home by None given The many other statistical tests used populations and
in self-esteem in elderly nurses was not specified. Participants 'computer time' lead to suspicion that the authors had settings, assuming it
clients. ranged from 0.32 hours to 50.39 hours over the 3- Process details no prospective analysis plan. is appropriately
month period. Data collection methods adapted.
Recruitment: interview Adverse effects:
Not stated Duration: none
3 months Statistical methods
Setting: T-tests evaluated the self-esteem scale scores to
Participants’ homes Intensity: check for equality by comparing group means. T-
n/a tests were used to determine if there were
Country: differences in computer time between training level

Not stated. Authors from Comparator:Control Group IV: Participants received Groups I, II and III. T-tests and Fischer Exact tests
Houston, Texas, USA weekly nurse visits but no computer terminal or (after dichotomising scores) were used to investigate
computer training. the association between training levels and pre-
Funding Source: poststudy changes in self-esteem. After averaging
US Videotel provided Population details the different compared training/control group
computer terminals for the Inclusion: (1) lived in a private residence (2) were 65 variances to obtain a shared variance of compared
study. years of age and older (3) had good vision and (4) training/control groups, an effect size was calculated
had no previous computer experience. for compared groups. Multiple regression tests
Exclusion none stated analysed the strength of the relationship between
Unit of allocation: individual self-esteem and different training methods.

Total n = 40 Unit of analysis individual
Intervention: n = 10 in each group
Comparator n = 10 Unit of allocation: individual

Gender: 82% female, 18% male
Mean age (range): M=73 Time to follow up:
3 months from start of study
SES:
Some variation Mental well-being measure(s):
The Rosenberg Self-Esteem Scale (Rosenberg
1965).

Power calculation:
unclear
9
PHIAC 17.15 Mental Well-being and Older People: Evidence Tables

Study Details Intervention and population details Analyses Results Comments
A significant difference was found for
Bower & Greene (1995). The intervention aimed to investigate the effect of Baseline comparability: attitude toward one’s own aging This study is too small and of a
different types of activity. This consisted of 3 No significant differences and randomised comparing individuals in the altruistic poor design..
Controlled non- condition groups: 1) making holiday baskets for to each group. condition to those in the non-altruistic
randomised trial [NCT] families with special needs (described as altruistic condition.
(quality rating -) activity) 2) non-altruistic activity with occupational Attrition
therapy such as playing cards or crafts 3) Number of participants completing Older adults involved in the altruistic Applicability:
Objective: conversation with occupational therapy. study: N =32. activity exhibited a more positive This is an American study and
To investigate the effect of attitude than those in the non-altruistic it is unclear whether the
different types of activity Providers/Deliverers: Reasons for non-completion: condition (P = .022). However, the findings are applicable to
on older adults in long Occupational therapists. Not relevant. altruistic condition participants scored populations and settings in the
term care facilities. lower in positive attitude than UK.
Length: 1 hour. Process details participants in the conversational
Recruitment: Duration: 5 weeks. Data collection methods: condition, whose scores indicated a
Activity directors at 5 Intensity: Weekly. Self-report. significantly more positive attitude
nursing homes identified than those in the altruistic condition (P
people that they thought Comparator: Statistical methods: = .007)
were appropriate to take 2 other groups with activity to compare with Kruskal Wallis ANOVA.
part. intervention group: group 2 = non-altruistic activity The altruistic group also scored
with OT such as playing cards or craft. Group 3 = Unit of analysis: significantly lower in attitude (P =
Setting: conversation with OT. Control group undertook those Individual. .013) than those in the regularly
Nursing home. activities in the nursing home that they normally scheduled group activity. There were
would. Time to follow up: no significant differences involving the
Country: Followed-up to end of intervention. altruistic group participants
USA. Population details considering the PGC Morale Scale.
Inclusion: Those judged to be able to participate by Mental well-being measure(s):
Funding Source: activity directors. Revised Philadelphia Geriatric Center The non-altruistic group scored
Not reported but is a (PGC) Moral Scale significantly lower in attitude toward
Masters dissertation Exclusion: Not reported. Power calculation: Not reported. aging than participants in the
project. conversational condition (P = .001)
Unit of allocation: Individual. and those in the group activity
condition (P = .003). Participants in
Total: 32 (6 in the control that did not receive any the non-altruistic condition also
intervention) rest randomised to three interventions. scored significantly lower than those
Intervention: Not reported. in the conversational (P= .013) and
Comparator: Not reported. the group activity (P = .018)
conditions in agitation.
Gender: 26 female and 6 male.
Adverse effects:
Mean age (range): Not reported but states None reported.
participants are over 65 years.

SES: Not reported.

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