Health service use and outcome: comparison of low charge, integrated, comprehensive services with usual health care

Integration and continuity of Care in health care network models for frail older adults

A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.

Prevalence and correlates of functional status in an older community--representative sample in Brazil

OBJECTIVE

Information on dependency level of elderly in rapidly aging developing countries is limited, but this is needed to ascertain the extent of need for help with activities of daily living (ADLs).

METHOD

In-person information was obtained in 1995 from a statewide survey of representative community residents >/=60 years of age in the state of Rio Grande do Sul, Brazil (N = 7,040), on demographic characteristics, health conditions, social ties, health behaviors, and ADL performance.

RESULTS

Nearly 40% needed help with one or more ADLs. In controlled analyses, need for help approximately doubled with each succeeding decade. Increased education and income and regular physical activity reduced risk. Selected health conditions (stroke, depression, poor self-rated health) were consistently associated with need for help.

DISCUSSION

A large proportion of noninstitutionalized elderly have ADL problems. In addition to health care, interventions promoting equity of access to education and economic opportunity could reduce ADL dependency in coming generations.