Mindful management trial for older people with LTCs

April 2016 Vol 16 (2)

As our population ages, more and more people are living into old age with multiple long-term conditions. A University of Otago nurse-led randomised controlled trial is looking at whether training in both healthy living and mindfulness can make a difference to these people’s lives.

 

Beverley Burrell 2 CMYKCantabrians into their early nineties are being introduced to the principle of mindfulness as part of a healthy living education pilot.

Dr Beverley Burrell, from Otago’s Centre for Postgraduate Nursing Studies in Christchurch is principal investigator for the randomised controlled trial (RCT) of the education intervention for over-65-year-olds in Canterbury living independently with more than one long-term condition (LTC).

She says it decided to look at older people both because of the ageing population and also the shift in recent years to policy encouraging and supporting older people to stay in their own homes and be as independent as possible for as long possible.

“And then we looked at people with more than one LTC because of the complexity in managing themselves at home and keeping themselves well.”

Research had shown that self-management programmes have had some success but some of the existing ones were quite long – often eight weeks – and it decided to look at a shorter intervention for an older population where attending something regularly could be burdensome. With some evidence also available on the effectiveness of mindfulness training, they decided on a two-hour small group intervention delivered once a week for four weeks that combined standard self-management education with mindfulness education.

The study, funded by a two-year grant from the Canterbury Medical Research Foundation, is now at the midway point, with the last intervention programme being delivered this winter.

Burrell says it has had a good response from the participants, who are aged from 65 right through to their late 80s, including one 92-year-old.

The RCT is using a wait-list control system. Once 20 people are signed up to the trial, 10 are randomised to receive the intervention straightaway and 10are wait-listed to receive it at a later time. Burrell says this means equity for participants as everybody gets the intervention.

All participants are surveyed on entering the trial on their health-related quality of life (HRQL) and other factors like medication adherence, nutrition, sleep and self-management. Then they are surveyed six weeks after the intervention – when the findings from the ‘exit point’ of the intervention group can be compared with the ‘entry point’ of the control group – and finally three months post-intervention.

Burrell says each intervention session is divided in half, with the first hour being self-management education, delivered by nurses and nurse practitioners, that includes areas like medication management, healthy living, information on local services, and symptom management of generic symptoms like pain, breathlessness and fatigue.

The second hour is a mindfulness session, led by a clinical psychologist, which takes a cognitive behaviour therapy (CBT) approach and includes areas like goal setting, values clarification, ‘acceptance’ concepts related to their conditions and skills on how to cope and reduce worrying about their conditions. Meditation is not a major part of the programme, but there is a short exercise with a recording that can be taken home.

The researchers hope that the combined intervention will be effective in helping people to gain the confidence and ability to cope better with their LTC and improve their HRQL. ✚

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