Katarzyna Szczerbińska

The associations between stages of behavioral change, their conditons and health behaviors concerning physical activity and nutrition of older patients covered with community nurses care in Kraków. Implications for health promotion

In frame of the European Project CHANGE (Care of Health Advertising New Goals for Elderly people) the study of health behaviours regarding healthy nutrition and physical activity was conducted on patients in age of 60 and more covered with care of community nurses. Objectives: To assess association between physical activity and nutritional habits, stages of change of these behaviors among older patients and other psychosocial conditions regarding planning of health education intervention to change their health behaviours.

Methods: 108 persons at age avg. 69.6 (SD 60–87) were interviewed by questionnaire (assessing the frequency of intake of particular food products, physical activity, motivation and stage of change these behaviors, satisfaction with physical condition and general wellbeing) by the trained community nurses.

Results: Results showed sedentary style of life in most studied patients. Among physical activity the frequency of daily walking was the highest (69%), while 70% of older people did not exercise. In study group 42% were not aware of importance of physical activity for their health. But the awareness of importance of healthy nutrition was high, and about half of study group (48%) reported that they eat meals with reduced fat, and 80% eat high fiber food. The rules of healthy nutrition were not fully respected. Positive correlations were shown between intention to change, stage of change of health behavior and performance of physical activity and healthy eating. Those behaviors were positively related to well-being and satisfaction with physical condition.

Conclusions: Health promotion programs for older patients should be planned in different way depending on their stage of change of health behaviors. There is a need to raise awareness of importance of physical activity, and to educate older patients about recommended types of exercises and recreation. In case of recommendations of healthy nutrition, the awareness is high and performance definitely more frequent, therefore health promotion programs should stimulate development of permanent social support to maintain change of these behaviors.

The charter of older people rights to participate in clinical trials

The results of initial literature review indicate that elderly persons are underrepresented in the clinical trials on which clinical recommendations are based. This gave stimulus to perform the ‘Increasing the PaRticipation of the ElDerly In Clinical Trials’ (PREDICT) project, financed by the EU within the FP7. The goal of the PREDICT was to study reasons why older people are excluded from clinical trials based on age-related criteria and development of the charter including recommendations to prevent their exclusion. The project gathered investigators from 11 institutions in 9 countries: Czech Republic, Israel, Italy, Lithuania, the Netherlands, Poland, Romania, Spain, and the UK. Within the scope of PREDICT, first, to assess the scope of the problem the systematic review of literature was performed, then the opinion shared by the health care professionals, ethicists, and representatives of pharmaceutical industry on the possible reasons of underrepresentation of old people in trials was examined, then finally the opinion of elderly patients and their caregivers were assessed. The analysis of gathered data enabled creation of PREDICT charter which contains recommendations aiming to increase the participation of elderly people in clinical trials

End-of-life communication between the physician and the relative of dying nursing home residents

The aim of this paper was to summarize the current knowledge about the end-of-life (EOL) communication between the physician and the relative of dying nursing home (NH) residents. A review of literature showed that relatives of dying residents reported low satisfaction with quality of communication with a physician. The relatives complained they were not informed about the residents’ condition, did not understand the information provided by the physician and did not participate in the discussion about the residents’ wishes concerning medical treatment. In conclusion, (1) the concept of quality of EOL communication between the physician and the relatives of the dying NH residents still has no well-grounded foundation, (2) the number of tools for evaluation of EOL communication in the NH is limited, (3) physician-family communication is one of the most important aspects of care at the EOL, (4) many factors may influence it, but one of the most important is the availability of a physician in the NHs.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.