The feasibility, effects and costs of the ‘Stay Active at Home’ programme

Evaluation of a preventive integral approach in primary care that stimulates physical activity among community-dwelling older adults

Project leader: Prof. Ruud Kempen
Researchers: Dr Silke Metzelthin, Dr Rixt Zijlstra, Dr Erik van Rossum
Period: 2017-2021

The aim of the proposed study is to provide evidence about the (cost-) effectiveness of ‘Stay Active at Home’ prior to dissemination and implementation of the programme. Alongside the trial an extensive process evaluation will be conducted. ‘Stay Active at Home’ is not an additional, (classical) exercise programme; physical activity is integrated in usual care. In the Netherlands, many older adults receive regularly homecare services or visits from a practice nurse of their GP. However, professionals tend to meet their clients’ needs by task completion rather than by stimulating self-management and active engagement in tasks. Thereby they deprive older adults of their opportunities to engage in a routine range of movements resulting in further functional decline. To prevent these negative consequences ‘Stay Active at Home’ aims to change the behaviour of healthcare professionals from ‘doing things for older adults’ to ‘engaging older adults’ in daily life in order to improve physical activity among older adults by reducing their sedentary time. For example, washing the upper body and face independently; changing the pillowcase, while professional changes bedcover; and motivating clients to join a dancing class at the community centre. Thereby older adults will be continuously stimulated during regular care moments, in a one-to-one relationship to participate in daily and physical activities and to decrease their sedentary time. It is assumed that this approach facilitates a long-term behavioural change in older adults. ‘Stay Active at Home’ is systematically developed based on international evidence in close collaboration with Dutch stakeholders. The feasibility of the programme and the proposed study design are evaluated in two pilot studies prior to the grant period. However, the (cost-) effectiveness of ‘Stay Active at Home’ is not yet known.

The study funded by the Prevention Programme of ZonMW comprises of a quasi-experimental design with 12 months follow-up will be conducted comparing two districts in the region Eastern South Limburg. In one district all homecare teams from MeanderGroep Zuid-Limburg and the practice nurses of the local GP practice will be trained in ‘Stay Active at Home’ (intervention group). A comparable district will deliver usual care (control group). Data will be collected from participating healthcare professionals and older adults. Older adults have to fulfil the following inclusion criteria: 1) receiving homecare services; and 2) having a high level of sedentary behaviour (> 10 hours/ day; measured by means of the LASA questionnaire). The primary outcome is sedentary behaviour (min/day) measured by means of a wrist-worn accelerometer. Secondary outcomes (i.e. physical and psychological functioning, falls, daily functioning, health-related quality of life, nursing home admission, healthcare utilisation/costs and mortality) will be collected by performance-based and self-reported measures. Data for the economic evaluation will be collected by means of a self-developed cost questionnaire, which will be assessed at baseline and after 6 and 12 months. For the process evaluation a mixed-methods design will be applied. Qualitative and quantitative techniques will be used to analyse the data.