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van der Ploeg T, Gobbens RJJ. Disability transitions in Dutch community-dwelling older people aged 75 years or older. Arch Gerontol Geriatr 2024; 116:105165. [PMID: 37639841 DOI: 10.1016/j.archger.2023.105165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Recent world population predictions show that the world population aged >=65 years will increase from 10% in 2022 to 16% in 2050. Population aging is accompanied by an increase in people with disability. It is important to pay special attention to people with disability, as these people are at high risk of adverse outcomes. Our study aimed to investigate the transitions of disability among Dutch community-dwelling older people aged 75 years or older, using a follow-up of nine years. We used socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events to predict the disability transitions over time. METHODS We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed part A of the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year follow-up. Paired Wilcoxon tests were used to compare the consecutive measurements. Socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events were included to predict the disability transitions over time. For the univariable and multivariable analysis of the measurements over time with the predictor variables, we used generalized estimation equations (GEE). A p-value <0.05 was considered significant. R version 3.4.4 was used for all analyses. RESULTS Of the participants, 65% were younger than 80 years, 50% were married or cohabiting, 87% reported a healthy lifestyle, and 63% had no diseases or chronic disorders. Each year, more participants changed from status not disabled to disabled than vice versa. The GEE analyses showed that lifestyle ('not healthy') and diseases or chronic disorders ('two or more') were significant in the multivariable analysis for the disability score and only diseases or chronic disorders ('two or more') was significant in the multivariable analysis for the dichotomous disability score. CONCLUSIONS The transition of the disability score is strongly influenced by lifestyle and diseases or disorders. This applies to a lesser extent to the dichotomous disability score. There, only diseases or disorders are an important predictor. For health care professionals our study provides starting points for interventions focused on the prevention of worsening disability and for community-dwelling older people >= 75, the most important recommendation is: live healthy!
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Affiliation(s)
- Tjeerd van der Ploeg
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands.
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands; Zonnehuisgroep Amstelland, Amstelveen, The Netherlands; Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, The Netherlands
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Han Y, Xu C, Zhang L, Wu Y, Fang Y. Expenditure projections for community home-based care services for older adults with functional decline in China. Int J Equity Health 2023; 22:143. [PMID: 37516872 PMCID: PMC10385915 DOI: 10.1186/s12939-023-01954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/06/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION Difficulty in identifying the functional status of older adults creates an imbalance between the supply and demand for community home-based care. Using a multi-level functional classification system to guide care cost measurement may optimize care resources and meet diverse eldercare demands. METHODS The Markov model was used to project the older population size in different functional decline (FD) statuses. The project cost and the man-hour costing method were combined to forecast the cost of community home-based care for older adults with FD. RESULTS The projected cost of eldercare increased from 1668.623 billion yuan in 2020 to 2836.754 billion yuan in 2035. By 2035, the total cost for community-based home care for those in pathological development of FD statuses such as "viability disorder," "acute disease," "somatic functional disorder," and "sub-disorder" was projected to be 1094.591 billion, 433.855 billion, 1256.236 billion, and 52.072 billion yuan, respectively, which is 1.24, 1.58, 1.78, and 0.49 times higher than the results by the man-hour costing method. Family caregiving costs are about three times those of professional caregivers. CONCLUSION The escalating cost of providing graded care for older adults, particularly by family caregivers, presenting a significant evidence for the need to optimize resource allocation and develop a robust human resources plan for community home-based care.
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Affiliation(s)
- Ying Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, Fujian, 361102, PR China
| | - Chuanhai Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, Fujian, 361102, PR China
| | - Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, Fujian, 361102, PR China
- School of Economics, Xiamen University, 422 Siming South Road, Xiamen Fujian, 361005, PR China
| | - Yafei Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, Fujian, 361102, PR China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, Fujian, 361102, PR China.
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von Renteln-Kruse W, Neumann L, Vinyard D, Golgert S, Thiem U, Dapp U. Funktionale Krankheitsfolgen von Menschen im Alter ab 70 Jahren und die Akzeptanz eines neuen Unterstützungs-Netzwerkes, das NetzWerk GesundAktiv (NWGA). Dtsch Med Wochenschr 2022; 147:e116-e127. [PMID: 36323325 PMCID: PMC9668487 DOI: 10.1055/a-1933-7483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Einleitung
Häufigere Pflegebedürftigkeit bei steigender Lebenserwartung ist problematisch. Das NetzWerk GesundAktiv (NWGA) nimmt positive Beeinflussbarkeit der Entwicklung von Pflegebedürftigkeit an. In einer Pilotregion Hamburgs luden gesetzliche Krankenversicherungen ihre Versicherten im Alter ab 70 Jahren zur Teilnahme am NWGA Hilfs- und Betreuungsnetzwerk ein. Hier werden die Ergebnisse der Akzeptanzanalyse dargestellt.
Methoden
Zur Fokussierung auf die Zielgruppe der für die Entwicklung von Pflegebedürftigkeit gefährdeten Personen wurde der LUCAS Funktions-Index (Selbstausfüll-Fragebogen) als Screening für den Grad funktionaler Kompetenz verwendet. Die retrospektive Beobachtungsstudie untersuchte explorativ NWGA Teilnehmende, Ablehnende, Interessenten (Ausschluss, da funktional kompetent) und Non-Responder anhand sozio-demografischer sowie Morbiditätsbezogener Routinedaten. Dafür wurden ICD-Diagnosen anlässlich stationärer Krankenhausaufenthalte, die Anzahl ambulanter Arztkontakte sowie Pflegegrade innerhalb 12 Monaten vor Rekrutierung verwendet.
Ergebnisse
Von 13 100 angeschriebenen Versicherten waren 962 Teilnehmende (7,4 %), 948 Ablehnende (7,2 %), 2437 Interessenten (18,6 %) und 8753 Non-Responder (66,8 %). Bezüglich soziodemografischer Merkmale unterschieden sich diese Gruppen. Die Diagnosen von 5422 Krankenhausaufenthalten zeigten unterschiedlich häufige ICD-Codes funktionaler Beeinträchtigungen. Interessenten waren praktisch nicht pflegebedürftig und wiesen die niedrigste Morbidität auf.
Diskussion
Die Ergebnisse weisen darauf hin, dass Beeinträchtigungen insbesondere motorischer und kognitiver Funktionen sowie soziodemografische Merkmale die NWGA-Akzeptanz beeinflussen. Die Ansprache zur Teilnahme sollte entsprechend differenziert verbessert werden. Die Berücksichtigung funktionaler Störungen als Krankheitsfolgen und Schrittmacher von Pflegebedürftigkeit könnte Gesundheitsförderung und Prävention im Alter generell stärken. Das Interesse für präventive Aktivitäten war unter den 70-jährigen und älteren Menschen nennenswert häufig.
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Affiliation(s)
- Wolfgang von Renteln-Kruse
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
- Emeritus, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Lilli Neumann
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
| | - Dominic Vinyard
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
| | - Stefan Golgert
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
| | - Ulrich Thiem
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
- Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Ulrike Dapp
- Albertinen-Haus – Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg
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Zhang L, Shen S, Guo Y, Fang Y. Forecasting Future Demand of Nursing Staff for the Oldest-Old in China by 2025 Based on Markov Model. Int J Health Policy Manag 2022; 11:1533-1541. [PMID: 34273928 PMCID: PMC9808353 DOI: 10.34172/ijhpm.2021.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/03/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND An aging population and an increase in the proportion of disabled elderly have brought an unprecedented global challenge, especially in China. Aside lack of professional long-term care facilities, the shortage of human resource for old-age care is also a major threat. Therefore, this study tries to forecast the demand scale of nursing staff for the oldest-old in 2025 in China servicing as a reference for the development plan of human resource for elderly nursing. METHODS Based on CLHLS (Chinese Longitudinal Healthy Longevity Survey) 2011 and 2014, Logit model was used to construct the transition probability matrix of the elderly's health status (health/mild/moderate/severe disability and death). By using the data of the elderly population aged 65 or over in the 2010 national population census, we projected the number of Chinese oldest-old population in different health status by 2025 through Markov model and projected the scale of the demand of nursing staff combined with the human population ratio method. RESULTS The forecast shows that the Chinese oldest-old population is about 52.6 million, among which 46.9 million are healthy, 3.7 million are mild, 0.8 million are moderate, and 1.2 million are severely disabled in 2025. Concurrently, the demand scale of nursing staff will be 5.6 million according to the low standard and 11.5 million according to the high standard. Thus, human resource supply of long-term care is worrying. CONCLUSION In 2025, the population size of the Chinese oldest-old will be further expanded, and the demand of care will increase accordingly, leading to a vast gap in the nursing staff. Therefore, it is urgent to build a professional nursing staff with excellent comprehensive quality and reasonable quantity, to ensure the sustainable development of China's elderly care service industry.
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Affiliation(s)
- Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Fujian, China
- School of Economics, Xiamen University, Fujian, China
| | - Shuyuan Shen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Fujian, China
| | - Yaqian Guo
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Fujian, China
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Incidence and Predictive Factors of Functional Decline in Older People Living in Nursing Homes: A Systematic Review. J Am Med Dir Assoc 2022; 23:1815-1825.e9. [DOI: 10.1016/j.jamda.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022]
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Zingmark M, Norström F. Transitions between levels of dependency among older people receiving social care - a retrospective longitudinal cohort study in a Swedish municipality. BMC Geriatr 2021; 21:342. [PMID: 34078277 PMCID: PMC8173751 DOI: 10.1186/s12877-021-02283-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Knowledge is scarce on how needs for home help and special housing evolve among older people who begin to receive support from municipal social care. The purpose of this study was to describe baseline distributions and transitions over time between levels of dependency among older persons after being granted social care in a Swedish municipality. Methods Based on a longitudinal cohort study in a Swedish municipality, data was collected retrospectively from municipal records. All persons 65 years or older who received their first decision on social care during 2010 (n = 415) were categorized as being in mild, moderate, severe, or total dependency, and were observed until the end of 2013. Baseline distributions and transitions over time were described descriptively and analysed with survival analysis, with the Kaplan-Meier estimator, over the entire follow-up period. To test potential differences in relation to gender, we used the Cox-Proportional hazards model. Results Baseline distributions between mild, moderate, severe, and total dependency were 53, 16, 24, and 7.7%. During the first year, between 40 and 63% remained at their initial level of dependency. Among those with mild and moderate levels of dependency at baseline, a large proportion declined towards increasing levels of dependency over time; around 40% had increased their dependency level 1 year from baseline and at the end of the follow-up, 75% had increased their dependency level or died. Conclusions Older people in Sweden being allocated home help are at high risk for decline towards higher levels of dependency, especially those at mild or moderate dependency levels at baseline. Taken together, it is important that municipalities make use of existing knowledge so that they implement cost-effective preventative interventions for older people at an early stage before a decline toward increasing levels of dependency.
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Affiliation(s)
- Magnus Zingmark
- Municipality of Östersund, Health and Social Care Administration, 83182, Östersund, Sweden. .,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Bimou C, Harel M, Laubarie-Mouret C, Cardinaud N, Charenton-Blavignac M, Toumi N, Trimouillas J, Gayot C, Boyer S, Hebert R, Dantoine T, Tchalla A. Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults. BMC Geriatr 2021; 21:142. [PMID: 33637045 PMCID: PMC7908646 DOI: 10.1186/s12877-021-02063-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people's independence trajectories and associated risk factors would enable the develop early intervention strategies. METHODS Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011-November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the "Functional Autonomy Measurement System (Système de Mesure de l'Autonomie Fonctionnelle (SMAF))". Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory. RESULTS Three distinct trajectories of independence were identified including a "Stable functional autonomy (SFA) trajectory" (53% of patients), a "Stable then decline functional autonomy decline (SDFA) trajectory" (33% of patients) and a "Constantly functional autonomy decline (CFAD) trajectory" (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD. CONCLUSIONS Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.
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Affiliation(s)
- Charlotte Bimou
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France.
- Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France.
- Unité de Recherche Clinique et de l'Innovation en Gérontologie (URCI), Hôpital Jean Rebeyrol, CHU de Limoges, 87042, Limoges, France.
- HAVAE Laboratory, University of Limoges, 123 avenue Albert Thomas, F-87060, Limoges, France.
| | - Michel Harel
- Institut de Mathématiques de Toulouse et École Supérieure du Professorat et de l'Éducation à l'Université de Limoges, 87000, Limoges, France
| | - Cécile Laubarie-Mouret
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
- Unité de Recherche Clinique et de l'Innovation en Gérontologie (URCI), Hôpital Jean Rebeyrol, CHU de Limoges, 87042, Limoges, France
| | - Noëlle Cardinaud
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
- Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France
| | - Marion Charenton-Blavignac
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
- Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France
| | - Nassima Toumi
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
- Unité de Recherche Clinique et de l'Innovation en Gérontologie (URCI), Hôpital Jean Rebeyrol, CHU de Limoges, 87042, Limoges, France
| | - Justine Trimouillas
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
| | - Caroline Gayot
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
| | - Sophie Boyer
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
- Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France
- Unité de Recherche Clinique et de l'Innovation en Gérontologie (URCI), Hôpital Jean Rebeyrol, CHU de Limoges, 87042, Limoges, France
| | | | - Thierry Dantoine
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
- Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France
| | - Achille Tchalla
- CHU de Limoges, Pôle HU Gérontologie Clinique, Service de Médecine Gériatrique, Unité de Prévention de Suivi et d'Analyse du Vieillissement (UPSAV), CHU Limoges, 2 Avenue Martin-Luther King, F-87042, Limoges, France
- Université de Limoges; EA 6310 HAVAE Handicap Activité Vieillissement Autonomie Environnement, F-8705, Limoges, France
- Unité de Recherche Clinique et de l'Innovation en Gérontologie (URCI), Hôpital Jean Rebeyrol, CHU de Limoges, 87042, Limoges, France
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Lambert AS, Ces S, Malembaka EB, Van Durme T, Declercq A, Macq J. Evaluation of bottom-up interventions targeting community-dwelling frail older people in Belgium: methodological challenges and lessons for future comparative effectiveness studies. BMC Health Serv Res 2019; 19:416. [PMID: 31234857 PMCID: PMC6592000 DOI: 10.1186/s12913-019-4240-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/10/2019] [Indexed: 01/27/2023] Open
Abstract
Background Optimizing the organization of care for community-dwelling frail older people is an important issue in many Western countries. In Belgium, a series of complex, innovative, bottom-up interventions was recently designed and implemented to help frail older people live at home longer. As the effectiveness of these interventions may vary between different population groups according to their long-term care needs, they must be evaluated by comparison with a control group that has similar needs. Methods The goal was to identify target groups for these interventions and to establish control groups with similar needs and to explore, per group, the extent to which the utilization of long-term care is matched to needs. We merged two databases: a clinical prospective database and the routine administrative database for healthcare reimbursements. Through Principal Component Analysis followed by Clustering, the intervention group was first stratified into disability profiles. Per profile, comparable control groups for clinical variables were established, based on propensity scores. Using chi-squared tests and logistic regression analysis, long-term care utilization at baseline was then compared per profile and group studied. Results Stratification highlighted five disability profiles: people with low-level limitations; people with limitations in instrumental activities of daily life and low-level of cognitive impairment; people with functional limitations; people with functional and cognitive impairments; and people with functional, cognitive, and behavioral problems. These profiles made it possible to identify long-term care needs. For instance, at baseline, those who needed more assistance with hygiene tasks also received more personal nursing care (P < 0.05). However, there were some important discrepancies between the need for long-term care and its utilization: while 21% of patients who were totally dependent for hygiene tasks received no personal nursing care, personal nursing care was received by 33% of patients who could perform hygiene tasks. Conclusions The disability profiles provide information on long-term care needs but not on the extent to which those needs are met. To assess the effectiveness of interventions, controls at baseline should have similar disability profiles and comparable long-term care utilization. To allow for large comparative effectiveness studies, these dimensions should ideally be available in routine databases. Electronic supplementary material The online version of this article (10.1186/s12913-019-4240-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne-Sophie Lambert
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium.
| | - Sophie Ces
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium
| | - Espoir Bwenge Malembaka
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium.,Ecole Régionale de Santé Publique (ERSP), Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Thérèse Van Durme
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium
| | - Anja Declercq
- LUCAS and Center for Sociological Research, KU Leuven, Leuven, Belgium
| | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium
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Zingmark M, Norström F, Lindholm L, Dahlin-Ivanoff S, Gustafsson S. Modelling long-term cost-effectiveness of health promotion for community-dwelling older people. Eur J Ageing 2019; 16:395-404. [PMID: 31798365 PMCID: PMC6857142 DOI: 10.1007/s10433-019-00505-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.
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Affiliation(s)
- Magnus Zingmark
- Health and Social Care Administration, Municipality of Östersund, 83182 Östersund, Sweden.,2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Fredrik Norström
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Lars Lindholm
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Synneve Dahlin-Ivanoff
- 3Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,4University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden
| | - Susanne Gustafsson
- 3Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,4University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden
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Yau K, Farragher JF, Kim SJ, Famure O, Jassal SV. A Longitudinal Study Examining the Change in Functional Independence Over Time in Elderly Individuals With a Functioning Kidney Transplant. Can J Kidney Health Dis 2018; 5:2054358118775099. [PMID: 29899998 PMCID: PMC5985553 DOI: 10.1177/2054358118775099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 02/02/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Functional disability is defined as the need for assistance with self-care
tasks. Objective: To document changes in functional status over time among older prevalent
renal transplant recipients. Design: Single center, prospective, follow-up study. Setting: Single center, tertiary care transplant center. Patients: Patients, with a functioning kidney transplant, aged 65 years or older who
underwent assessment of functional status approximately 12 months
previously. Measurements: Validated tools used included Barthel Index, the Lawton-Brody Scale of
Instrumental Activities of Daily Living, the Timed Up and Go test, the
Veterans Specific Activity Questionnaire, the Mini-Cog, and dynamometer
handgrip strength. Methods: Outpatient assessment by a trained observer. Results: Of the 82 patients previously studied, 64 (78%) patients participated in the
follow-up study (mean age 70.5 ± 4.4 years, 58% male, 55% diabetic). Among
those completing functional status measures, 32 (50%) had functional
disability at baseline. Over the 1-year period, 11 (17%) of these patients
experienced progressive functional decline, 6 (9%) exhibited no change, and
15 (23%) had functional recovery. Eleven patients (17%) initially
independent, developed new-onset disability. One of the strongest predictors
of progressive functional decline was having 1 or more falls in the previous
year. Limitations: Assessments were performed only on 2 occasions separated by approximately 1
year. Conclusions: Fluctuations in disability states are common among older adults living with
renal transplants. Episodes of functional disability may place individuals
at higher risk of persistent and/or progressive disability.
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Affiliation(s)
- Kevin Yau
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Janine F Farragher
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Olusegun Famure
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Sarbjit V Jassal
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Jerez-Roig J, de Brito Macedo Ferreira LM, Torres de Araújo JR, Costa Lima K. Functional decline in nursing home residents: A prognostic study. PLoS One 2017; 12:e0177353. [PMID: 28493946 PMCID: PMC5426763 DOI: 10.1371/journal.pone.0177353] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/26/2017] [Indexed: 12/16/2022] Open
Abstract
Aim To verify the probability of maintaining functional capacity in basic activities of daily living and identify the prognostic factors of functional decline in institutionalized older adults. Methods A longitudinal study is presented herein, with 5 waves every 6 months, throughout 2 years (2013–2015), conducted with individuals ≥60 years old in 10 nursing homes in the city of Natal-RN (Brazil). Functional capacity was assessed by the items ‘eating’, ‘personal hygiene’, ‘dressing’, ‘bathing’, ‘transferring’, ‘toileting’ and ‘walking’, through a 5-item Likert scale. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time dependent variables included continence decline, cognitive decline, increase in the number of medication, and incidences of falls, hospitalizations and fractures. The actuarial method, the log-rank test and Cox's regression were applied as statistical methods. Results The cumulative probability of functional maintenance was 78.2% (CI 95%: 72.8–82.7%), 65.1% (CI 95%: 58.9–70.5%), 53.5% (CI 95%: 47.2–59.5%) and 44.0% (CI 95%: 37.7–50.2%) at 6, 12, 18 and 24 months, respectively. Predicting factors for functional decline were: severe cognitive impairment (HR = 1.96; p = 0.001), continence decline (HR = 1.85; p = 0.002) and incidence of hospitalizations (HR = 1.62; p = 0.020), adjusted by the incidence of depression, age, education level, presence of chronic diseases and low weight. Conclusions The cumulative probability of maintaining functional capacity in institutionalized older adults was only 44% at the 2-year follow-up. Prognostic factors for functional decline included severe cognitive impairment, continence decline and incidence of hospitalizations.
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Affiliation(s)
- Javier Jerez-Roig
- Postgraduate Program in Collective Health, Odontology Department, Federal University of Rio Grande do Norte (UFRN), Avenida Salgado Filho 1787, Lagoa Nova, Natal-RN, Brazil
- Can Misses Hospital, Ibiza, Spain
- * E-mail:
| | - Lidiane Maria de Brito Macedo Ferreira
- Postgraduate Program in Collective Health, Odontology Department, Federal University of Rio Grande do Norte (UFRN), Avenida Salgado Filho 1787, Lagoa Nova, Natal-RN, Brazil
| | - José Rodolfo Torres de Araújo
- Postgraduate Program in Health Sciences, Center of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Av. Gustavo Cordeiro de Farias, s/n, Petrópolis, Natal RN, Natal-RN, Brazil
| | - Kenio Costa Lima
- Postgraduate Program in Collective Health, Odontology Department, Federal University of Rio Grande do Norte (UFRN), Avenida Salgado Filho 1787, Lagoa Nova, Natal-RN, Brazil
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Jerez-Roig J, de Brito Macedo Ferreira LM, Torres de Araújo JR, Costa Lima K. Dynamics of activities of daily living performance in institutionalized older adults: A two-year longitudinal study. Disabil Health J 2017; 10:279-285. [DOI: 10.1016/j.dhjo.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/08/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
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Zingmark M, Nilsson I, Norström F, Sahlén KG, Lindholm L. Cost effectiveness of an intervention focused on reducing bathing disability. Eur J Ageing 2016; 14:233-241. [PMID: 28936134 PMCID: PMC5587451 DOI: 10.1007/s10433-016-0404-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals’ quality of life and societal costs. The aim of this study was to evaluate long-term cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.
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Affiliation(s)
- Magnus Zingmark
- Division of Occupational Therapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,Graduate School in Population Dynamics and Public Policy, Umeå University, Umeå, Sweden.,Community Care Administration, Municipality of Östersund, 83182 Östersund, Sweden
| | - Ingeborg Nilsson
- Division of Occupational Therapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,ALC (Ageing and Living Conditions), Umeå University, Umeå, Sweden
| | - Fredrik Norström
- Epidemiology and Public Health, Umeå University, 90187 Umeå, Sweden
| | - Klas Göran Sahlén
- Epidemiology and Public Health, Umeå University, 90187 Umeå, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Epidemiology and Public Health, Umeå University, 90187 Umeå, Sweden
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Cassarly C, Martin RH, Chimowitz M, Peña EA, Ramakrishnan V, Palesch YY. Assessing type I error and power of multistate Markov models for panel data-A simulation study. COMMUN STAT-SIMUL C 2016; 46:7040-7061. [PMID: 29225407 PMCID: PMC5722228 DOI: 10.1080/03610918.2016.1222425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/29/2016] [Indexed: 01/21/2023]
Abstract
Ordinal outcomes collected at multiple follow-up visits are common in clinical trials. Sometimes, one visit is chosen for the primary analysis and the scale is dichotomized amounting to loss of information. Multistate Markov models describe how a process moves between states over time. Here, simulation studies are performed to investigate the type I error and power characteristics of multistate Markov models for panel data with limited non-adjacent state transitions. The results suggest that the multistate Markov models preserve the type I error and adequate power is achieved with modest sample sizes for panel data with limited non-adjacent state transitions.
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Affiliation(s)
- Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Renee’ H. Martin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Marc Chimowitz
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Edsel A. Peña
- Department of Statistics, University of South Carolina, Columbia, SC
| | | | - Yuko Y. Palesch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Bucher CO, Dubuc N, von Gunten A, Morin D. Measuring change in clinical profiles between hospital admission and discharge and predicting living arrangements at discharge for aged patients presenting behavioral and psychological symptoms of dementia. Arch Gerontol Geriatr 2016; 65:161-7. [DOI: 10.1016/j.archger.2016.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/18/2016] [Accepted: 03/20/2016] [Indexed: 10/22/2022]
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Energy and protein intakes and their association with a decline in functional capacity among diabetic older adults from the NuAge cohort. Eur J Nutr 2015; 55:1729-39. [DOI: 10.1007/s00394-015-0991-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 07/03/2015] [Indexed: 12/25/2022]
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The long-term effect of community-based health management on the elderly with type 2 diabetes by the Markov modeling. Arch Gerontol Geriatr 2014; 59:353-9. [PMID: 24929252 DOI: 10.1016/j.archger.2014.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 05/04/2014] [Accepted: 05/08/2014] [Indexed: 11/23/2022]
Abstract
The aim of this study was to assess the long-term effects of community-based health management on elderly diabetic patients using a Markov model. A Markov decision model was used to simulate the natural history of diabetes. Data were obtained from our randomized trials of elderly with type 2 diabetes and from the published literature. One hundred elderly patients with type 2 diabetes were randomly allocated to either the management or the control group in a one-to-one ratio. The management group participated in a health management program for 18 months in addition to receiving usual care. The control group only received usual care. Measurements were performed on both groups at baseline and after 18 months. The Markov model predicted that for every 1000 diabetic patients receiving health management, approximately 123 diabetic patients would avoid complications, and approximately 37 would avoid death over the next 13 years. The results suggest that the health management program had a positive long-term effect on the health of elderly diabetic patients. The Markov model appears to be useful in health care planning and decision-making aimed at reducing the financial and social burden of diabetes.
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Turjamaa R, Hartikainen S, Kangasniemi M, Pietilä AM. Living longer at home: a qualitative study of older clients' and practical nurses' perceptions of home care. J Clin Nurs 2014; 23:3206-17. [PMID: 25453125 DOI: 10.1111/jocn.12569] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To identify descriptions of older (75+) home care clients and practical nurses regarding the current structure of home care available for older clients and the elements promoting the ability of clients to continue living at home. BACKGROUND The ageing population is a major global challenge in social and health care. In many countries, the focus of care for older clients has shifted from institutional care towards a model of home care. Increasing attention has been paid to maximising the resources of older clients and aiming to support their living at home for as long as possible. DESIGN A descriptive qualitative study METHODS Data were collected from individual interviews by using videotaped home care visits as a tool for stimulated recall interviews. Two groups of participants were interviewed: 14 practical nurses and 23 older clients. Data were analysed by using the inductive content analysis. RESULTS Both participant groups, practical nurses and older home care clients, described home care as organisationally driven, but highlighted the importance of individual encounters. In addition, both groups noted that clients' living at home can be supported by offering individually designed care. Individually designed care refers to showing respect to clients' opinions and promoting their individual resources. CONCLUSION In order to be able to promote older home clients' living at home, the provided home care needs to be individually designed and must take into account clients' resources and their perspectives of meaningful and inspirational activities. RELEVANCE TO CLINICAL PRACTICE The information produced by this study can be used to promote older clients' living at home for as long as possible. Therefore, practical nurses are required the ability to recognise older clients' individual resources and design individual care plans accordingly.
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Dubuc N, Bonin L, Tourigny A, Mathieu L, Couturier Y, Tousignant M, Corbin C, Delli-Colli N, Raîche M. Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people. Int J Integr Care 2013; 13:e017. [PMID: 23882166 PMCID: PMC3718273 DOI: 10.5334/ijic.976] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 03/14/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The home care and services provided to older adults with the same needs are often inadequate and highly varied. Integrated care pathways (ICPs) can resolve these issues. The aim of this study was to develop the content of ICPs to follow-up frail and disabled community-dwelling older people. THEORY AND METHOD A RIGOROUS PROCESS WAS APPLIED ACCORDING TO A SERIES OF STEPS: identification of desirable characteristics and a theoretical framework; review of evidence-based practices and current practices; and determination of ICPs by an interdisciplinary task team. RESULTS ICPs are intended to prevent specific problems, maximize independence, and promote successful aging. They are organized according to a dynamic process: (1) needs assessment and assessment of risk/protection factors; (2) data-collection summary and goals identification; (3) planning of interventions from a client-centered view; (4) coordination, delivery, and follow-up; and (5) identification of variances, as well as review and adjustment of plans. CONCLUSION Once computerized, these ICPs will facilitate the exchange of information as well as the clinical decision-making process with a perspective to adequately matching the needs of an individual person with resources that delay or slow the progression of frailty and disability. Once aggregated, the data will also support managers in organizing teamwork and follow-up for clients.
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Affiliation(s)
- Nicole Dubuc
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, and Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Successfully integrating aged care services: a review of the evidence and tools emerging from a long-term care program. Int J Integr Care 2013; 13:e003. [PMID: 23687475 PMCID: PMC3653282 DOI: 10.5334/ijic.963] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 11/16/2012] [Accepted: 11/22/2012] [Indexed: 12/03/2022] Open
Abstract
Background Providing efficient and effective aged care services is one of the greatest public policy concerns currently facing governments. Increasing the integration of care services has the potential to provide many benefits including increased access, promoting greater efficiency, and improving care outcomes. There is little research, however, investigating how integrated aged care can be successfully achieved. The PRISMA (Program of Research to Integrate Services for the Maintenance of Autonomy) project, from Quebec, Canada, is one of the most systematic and sustained bodies of research investigating the translation and outcomes of an integrated care policy into practice. The PRISMA research program has run since 1988, yet there has been no independent systematic review of this work to draw out the lessons learnt. Methods Narrative review of all literature emanating from the PRISMA project between 1988 and 2012. Researchers accessed an online list of all published papers from the program website. The reference lists of papers were hand searched to identify additional literature. Finally, Medline, Pubmed, EMBASE and Google Scholar indexing databases were searched using key terms and author names. Results were extracted into specially designed spread sheets for analysis. Results Forty-five journal articles and two books authored or co-authored by the PRISMA team were identified. Research was primarily concerned with: the design, development and validation of screening and assessment tools; and results generated from their application. Both quasi-experimental and cross sectional analytic designs were used extensively. Contextually appropriate expert opinion was obtained using variations on the Delphi Method. Literature analysis revealed the structures, processes and outcomes which underpinned the implementation. PRISMA provides evidence that integrating care for older persons is beneficial to individuals through reducing incidence of functional decline and handicap levels, and improving feelings of empowerment and satisfaction with care provided. The research also demonstrated benefits to the health system, including a more appropriate use of emergency rooms, and decreased consultations with medical specialists. Discussion Reviewing the body of research reveals the importance of both designing programs with an eye to local context, and building in flexibility allowing the program to be adapted to changing circumstances. Creating partnerships between policy designers, project implementers, and academic teams is an important element in achieving these goals. Partnerships are also valuable for achieving effective monitoring and evaluation, and support to ‘evidence-based’ policy-making processes. Despite a shared electronic health record being a key component of the service model, there was an under-investigation of the impact this technology on facilitating and enabling integration and the outcomes achieved. Conclusions PRISMA provides evidence of the benefits that can arise from integrating care for older persons, particularly in terms of increased feelings of personal empowerment, and improved client satisfaction with the care provided. Taken alongside other integrated care experiments, PRISMA provides further evidentiary support to policy-makers pursuing integrated care programs. The scale and scope of the research body highlights the long-term and complex nature of program evaluations, but underscores the benefits of evaluation, review and subsequent adaptation of programs. The role of information technology in supporting integration of services is likely to substantially expand in the future and the potential this technology offers should be investigated and harnessed.
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