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Re-braiding the Strands of Life through Community Rehabilitation, Home Care, and Informal Support: A Longitudinal Collective Case Study. Can J Aging 2023; 42:80-91. [PMID: 35815762 DOI: 10.1017/s0714980822000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Limited research exists on the experiences of older adults participating in community rehabilitation. Our longitudinal, collective case study explored older adults' experiences while they engaged in community rehabilitation and home care services, as well as family caregivers' concurrent experiences. Drawing on interpretive description, we inductively analysed interview data gathered at three points over 3-6 months from six family dyads. Questions focused on activities of daily living, instrumental activities of daily living and other meaningful activities affected by changes in the older adult's health. From our thematic analysis, three themes emerged: (a) Centring community rehabilitation and home care services around the older adult and family; (b) Understanding the intricate interface of formal and informal supports; and (c) Supporting the meaningful aspects of life. Our findings suggest a metaphor of re-braiding, a reconfiguration of activities that requires increased integration of formal and informal supports within home care and community rehabilitation.
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Preitschopf A, Holstege M, Ligthart A, Groen W, Burchell G, Pol M, Buurman B. Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis. Age Ageing 2023; 52:6972294. [PMID: 36626320 PMCID: PMC9831263 DOI: 10.1093/ageing/afac300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increase. OBJECTIVE To assess the effects of OGR on the primary outcome functional performance (FP) and secondary outcomes: length of in-patient stay, re-admission rate, patients' and caregivers' quality of life, mortality and cost-effectiveness. We also aim to describe the organisation and content of OGR. METHODS Systematic review and meta-analysis. Five databases were queried from inception to July 2022. We selected randomised controlled trials written in English, focusing on multidisciplinary interventions related to OGR, included participants aged ≥65 and reported one of the main outcomes. A meta-analysis was performed on FP, patients' quality of life, length of stay and re-admissions. The structural, procedural and environmental aspects of OGR were systematically mapped. RESULTS We selected 24 studies involving 3,405 participants. The meta-analysis showed no significant effect on the primary outcome FP (activity). It demonstrated a significant effect of OGR on shortening length of in-patient stay (P = 0.03, MD = -2.41 days, 95%CI: [-4.61-0.22]). Frequently used elements of OGR are: inpatient start of OGR with an interdisciplinary rehabilitation team, close cooperation with primary care, an OGR coordinator, individual goal setting and education for both patient and caregiver. CONCLUSION This review showed that OGR is as effective as usual care on FP activity. It shows low certainty of evidence for OGR being effective in reducing the length of inpatient stay. Further research is needed on the various frequently used elements of OGR.
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Affiliation(s)
- Astrid Preitschopf
- Address correspondence to: Astrid D. Preitschopf, MSc, Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, de Boelelaan 1109, 1081 HV, Amsterdam, The Netherlands. Tel: (+31) 651260776.
| | - Marije Holstege
- Department of Research GRZPLUS; Omring and Zorgcirkel, Hoorn, The Netherlands,Department of Research Omring, Hoorn, The Netherlands,Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands
| | - Andrea Ligthart
- Department of Research GRZPLUS; Omring and Zorgcirkel, Hoorn, The Netherlands
| | - Wim Groen
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - George Burchell
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Margriet Pol
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands,Research Group Occupational Therapy: Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bianca Buurman
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
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Nyman A, Zingmark M, Lilja M, Guidetti S. Information and communication technology in home-based rehabilitation - a discussion of possibilities and challenges. Scand J Occup Ther 2023; 30:14-20. [PMID: 35245989 DOI: 10.1080/11038128.2022.2046152] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Information and communication technology (ICT) has been proven to have effect in terms of providing alternative ways to deliver rehabilitation services. The intention with this paper is to serve as a foundation for discussions regarding the future development, design, and delivery of home-based rehabilitation, including ICT.Aim: To reflect on and discuss the possibilities and challenges of using ICT in home-based rehabilitation services.Method and material: We use experiences and results from various projects to reflect on and discuss possibilities and challenges related to the use of ICT in home-based rehabilitation.Findings and discussion: We exemplify how ICT present new possibilities that can increase the quality of the rehabilitation process and improve access to services. We reflect on some challenges in the use of ICT, related to non-user-friendly solutions, to the specific rehabilitation situation, and a lack of technical support. At an organisational level, readiness to use ICT can impact the extent to which new solutions are integrated into practice.Conclusion: We emphasise that ICT has the potential to develop and improve service delivery and contribute to increased quality and accessibility of home-based rehabilitation.
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Affiliation(s)
- Anneli Nyman
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Magnus Zingmark
- Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Margareta Lilja
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational therapy and Physiotherapy, Karolinska University Hospital, Sweden
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Fulton S, Dunk P, Stiller K. Health-related quality of life improves over the duration of home-based rehabilitation services. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Home-based rehabilitation is an alternative to inpatient rehabilitation. There is little research evaluating its effect on health-related quality of life. This study aimed to investigate whether health-related quality of life improves with rehabilitation services provided in the home. Methods A prospective, single-arm, observational study was undertaken, involving 121 patients receiving home-based rehabilitation services. A health-related quality of life questionnaire was completed by participants at the start and completion of services (using the 5-Level EuroQol-5 Dimension instrument) and analysed descriptively. Changes in health-related quality of life were compared using paired sample t-tests. Multivariate regression analyses were undertaken to investigate the effects of various factors (eg age, gender, diagnostic category) on the observed changes in health-related quality of life. Results Improved health-related quality of life was found: more participants reported ‘no’ or ‘slight’ problems at completion than initially, and there were significant increases in index values (P<0.001) and EuroQol Visual Analogue Scale scores (P<0.001). Admission scores, diagnostic group and duration of home-based rehabilitation services influenced health-related quality of life. Conclusions Health-related quality of life improved from start to completion of home-based rehabilitation services. This may reflect natural recovery and/or the effect of the rehabilitation interventions. Health-related quality of life measures, such as the 5-Level EuroQol-5 Dimension instrument, may be useful to evaluate the effect of home-based rehabilitation.
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Affiliation(s)
- Shelley Fulton
- Rehabilitation In The Home, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Penny Dunk
- Rehabilitation In The Home, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Kathy Stiller
- Central Adelaide Local Health Network, Adelaide, Australia
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Hustoft M, Biringer E, Gjesdal S, Moen VP, Aβmus J, Hetlevik Ø. The effect of team collaboration and continuity of care on health and disability among rehabilitation patients: a longitudinal survey-based study from western Norway. Qual Life Res 2019; 28:2773-2785. [PMID: 31144204 PMCID: PMC6761089 DOI: 10.1007/s11136-019-02216-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate how changes in patient-rated health and disability from baseline to after rehabilitation were associated with communication and relationships in rehabilitation teams and patient-rated continuity of care. METHODS Linear models were used to assess the associations between relational coordination [RC] and Nijmegen Continuity Questionnaire-Norwegian version [NCQ-N] with changes in the World Health Association Disability Assessment Schedule 2.0 [WHODAS 2.0] and EuroQol EQ-VAS [EQ-VAS]. To express change in WHODAS 2.0 and EQ-VAS, the model was adjusted for WHODAS 2.0 and EQ-VAS baseline scores. Analyses for possible slopes for the various diagnosis groups were performed. RESULTS A sample of 701 patients were included in the patient cohort, followed from before rehabilitation to 1 year after a rehabilitation stay involving treatment by 15 different interprofessional teams. The analyses revealed associations between continuity of care and changes in patient-rated health, measured with EQ-VAS (all p values < 0.01). RC communication was associated with more improvement in functioning in neoplasms patient group, compared to improvement of health among included patient groups. The results revealed no associations between NCQ-N and WHODAS 2.0 global score, or between RC in the rehabilitation teams treating the patients and changes in WHODAS 2.0 global score. CONCLUSION The current results revealed that better personal, team and cross-boundary continuity of rehabilitation care was associated with better patient health after rehabilitation at 1-year follow-up. Measures of patient experiences with different types of continuity of care may provide a promising indicator of the quality of rehabilitation care.
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Affiliation(s)
- Merethe Hustoft
- Centre for Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway.
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | - Eva Biringer
- Section of Research and Innovation, Helse Fonna Local Health Authority, Haugesund/Stord, Norway
| | - Sturla Gjesdal
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Vegard Pihl Moen
- Centre for Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Jörg Aβmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
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Allen L, John-Baptiste A, Meyer M, Richardson M, Speechley M, Ure D, Markle-Reid M, Teasell R. Assessing the impact of a home-based stroke rehabilitation programme: a cost-effectiveness study. Disabil Rehabil 2018; 41:2060-2065. [PMID: 29631453 DOI: 10.1080/09638288.2018.1459879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Stroke is often a severe and debilitating event that requires ongoing rehabilitation. The Community Stroke Rehabilitation Teams (CSRTs) offer home-based stroke rehabilitation to individuals for whom further therapy is unavailable or inaccessible. The objective of this study was to evaluate the cost-effectiveness of the CSRT programme compared with a "Usual Care" cohort. Methods: We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35 years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year. Results: Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost = -$17,255; incremental effect = 1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care. Conclusions: The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods. Implications for Rehabilitation Ongoing rehabilitation following stroke is imperative for optimal recovery. Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible. The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.
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Affiliation(s)
- Laura Allen
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada.,b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - Ava John-Baptiste
- b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - Matthew Meyer
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada
| | - Marina Richardson
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada
| | - Mark Speechley
- b Department of Epidemiology and Biostatistics , Western University , London , Canada
| | - David Ure
- c St. Joseph's Health Care, Parkwood Institute , London , Canada
| | | | - Robert Teasell
- a Department of Aging, Rehabilitation, and Geriatric Care , Lawson Health Research Institute , London , Canada.,c St. Joseph's Health Care, Parkwood Institute , London , Canada.,e Schulich School of Medicine and Dentistry , University of Western Ontario, Physical Medicine and Rehabilitation , London , Canada
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Røsstad T, Salvesen Ø, Steinsbekk A, Grimsmo A, Sletvold O, Garåsen H. Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial. BMC Health Serv Res 2017; 17:275. [PMID: 28412943 PMCID: PMC5392928 DOI: 10.1186/s12913-017-2206-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/30/2017] [Indexed: 01/22/2023] Open
Abstract
Background Improved discharge arrangements and targeted post-discharge follow-up can reduce the risk of adverse events after hospital discharge for elderly patients. Although more care is to shift from specialist to primary care, there are few studies on post-discharge interventions run by primary care. A generic care pathway, Patient Trajectory for Home-dwelling elders (PaTH) including discharge arrangements and follow-up by primary care, was developed and introduced in Central Norway Region in 2009, applying checklists at defined stages in the patient trajectory. In a previous paper, we found that PaTH had potential of improving follow-up in primary care. The aim of this study was to establish the effect of PaTH—compared to usual care—for elderly in need of home care services after discharge from hospital. Methods We did an unblinded, cluster randomised controlled trial with 12 home care clusters. Outcomes were measured at the patient level during a 12-month follow-up period for the individual patient and analysed applying linear and logistic mixed models. Primary outcomes were readmissions within 30 days and functional level assessed by Nottingham extended ADL scale. Secondary outcomes were number and length of inpatient hospital care and nursing home care, days at home, consultations with the general practitioners (GPs), mortality and health related quality of life (SF-36). Results One-hundred and sixty-three patients were included in the PaTH group (six clusters), and 141 patients received care as usual (six clusters). We found no statistically significant differences between the groups for primary and secondary outcomes except for more consultations with the GPs in PaTH group (p = 0.04). Adherence to the intervention was insufficient as only 36% of the patients in the intervention group were assessed by at least three of the four main checklists in PaTH, but this improved over time. Conclusions Lack of adherence to PaTH rendered the study inconclusive regarding the elderly’s functional level, number of readmissions after hospital discharge, and health care utilisation except for more consultations with the GPs. A targeted exploration of prerequisites for implementation is recommended in the pre-trial phase of complex intervention studies. Trial registration Clinical Trials.gov NCT01107119, retrospectively registered 2010.04.18. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2206-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tove Røsstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,Department of Health and Welfare Services, Trondheim, Norway.
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anders Grimsmo
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian Health Net, Trondheim, Norway
| | - Olav Sletvold
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Helge Garåsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Health and Welfare Services, Trondheim, Norway
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[Feasibility of a geriatric multidisciplinary outpatient rehabilitation program-lessons learned]. Tijdschr Gerontol Geriatr 2016; 47:47-57. [PMID: 26821168 DOI: 10.1007/s12439-015-0164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the feasibility of a geriatric multidisciplinary outpatient rehabilitation program, developed in Vivium Naarderheem. DESIGN A prospective pilot study using a pretest-posttest design with measurements of the level of (social) participation, health related quality of life, and caregiver strain at the start (T0) and the end (T1) of the program. Feasibility was studied by structured interviews with participants, professionals and management. RESULTS We included 18 patients, fifteen of which were admitted after stroke. The program was highly appreciated by patients. Management and professionals thought that factors of influence on the program were transportation of patients, adequate planning and deployment of staff, and adequate financing. The program was regarded feasible. Although some patients reported a higher level of participation, the only statistically significant finding was a deterioration in self-perceived health. CONCLUSION In this study most of the patients participated after stroke. The geriatric multidisciplinary outpatient rehabilitation program, following inpatient geriatric rehabilitation, was highly appreciated by patients, and considered feasible by management and professionals.
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Brown L, Forster A, Young J, Crocker T, Benham A, Langhorne P. Medical day hospital care for older people versus alternative forms of care. Cochrane Database Syst Rev 2015; 2015:CD001730. [PMID: 26102196 PMCID: PMC7068157 DOI: 10.1002/14651858.cd001730.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The proportion of the world's population aged over 60 years is increasing. Therefore, there is a need to examine different methods of healthcare provision for this population. Medical day hospitals provide multidisciplinary health services to older people in one location. OBJECTIVES To examine the effectiveness of medical day hospitals for older people in preventing death, disability, institutionalisation and improving subjective health status. SEARCH METHODS Our search included the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register of Studies, CENTRAL (2013, Issue 7), MEDLINE via Ovid (1950-2013 ), EMBASE via Ovid (1947-2013) and CINAHL via EbscoHost (1980-2013). We also conducted cited reference searches, searched conference proceedings and trial registries, hand searched select journals, and contacted relevant authors and researchers to inquire about additional data. SELECTION CRITERIA Randomised and quasi-randomised trials comparing medical day hospitals with alternative care for older people (mean/median > 60 years of age). DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and risk of bias and extracted data from included trials. We used standard methodological procedures expected by the Cochrane Collaboration. Trials were sub-categorised as comprehensive care, domiciliary care or no comprehensive care. MAIN RESULTS Sixteen trials (3689 participants) compared day hospitals with comprehensive care (five trials), domiciliary care (seven trials) or no comprehensive care (four trials). Overall there was low quality evidence from these trials for the following results.For the outcome of death, there was no strong evidence for or against day hospitals compared to other treatments overall (odds ratio (OR) 1.05; 95% CI 0.85 to 1.28; P = 0.66), or to comprehensive care (OR 1.26; 95% CI 0.87 to 1.82; P = 0.22), domiciliary care (OR 0.97; 95% CI 0.61 to 1.55; P = 0.89), or no comprehensive care (OR 0.88; 95% CI 0.63 to 1.22; P = 0.43).For the outcome of death or deterioration in activities of daily living (ADL), there was no strong evidence for day hospital attendance compared to other treatments (OR 1.07; 95% CI 0.76 to 1.49; P = 0.70), or to comprehensive care (OR 1.18; 95% CI 0.63 to 2.18; P = 0.61), domiciliary care (OR 1.41; 95% CI 0.82 to 2.42; P = 0.21) or no comprehensive care (OR 0.76; 95% CI 0.56 to 1.05; P = 0.09).For the outcome of death or poor outcome (institutional care, dependency, deterioration in physical function), there was no strong evidence for day hospitals compared to other treatments (OR 0.92; 95% CI 0.74 to 1.15; P = 0.49), or compared to comprehensive care (OR 1.05; 95% CI 0.79 to 1.40; P = 0.74) or domiciliary care (OR 1.08; 95% CI 0.67 to 1.74; P = 0.75). However, compared with no comprehensive care there was a difference in favour of day hospitals (OR 0.72; 95% CI 0.53 to 0.99; P = 0.04).For the outcome of death or institutional care, there was no strong evidence for day hospitals compared to other treatments overall (OR 0.85; 95% CI 0.63 to 1.14; P = 0.28), or to comprehensive care (OR 1.00; 95% CI 0.69 to 1.44; P = 0.99), domiciliary care (OR 1.05; 95% CI 0.57 to1.92; P = 0. 88) or no comprehensive care (OR 0.63; 95% CI 0.40 to 1.00; P = 0.05).For the outcome of deterioration in ADL, there was no strong evidence that day hospital attendance had a different effect than other treatments overall (OR 1.11; 95% CI 0.68 to 1.80; P = 0.67) or compared with comprehensive care (OR 1.21; 0.58 to 2.52; P = 0.61), or domiciliary care (OR 1.59; 95% CI 0.87 to 2.90; P = 0.13). However, day hospital patients showed a reduced odds of deterioration compared with those receiving no comprehensive care (OR 0.61; 95% CI 0.38 to 0.97; P = 0.04) and significant subgroup differences (P = 0.04).For the outcome of requiring institutional care, there was no strong evidence for day hospitals compared to other treatments (OR 0.84; 95% CI 0.58 to 1.21; P = 0.35), or to comprehensive care (OR 0.91; 95% CI 0.70 to 1.19; P = 0.49), domiciliary care (OR 1.49; 95% CI 0.53 to 4.25; P = 0.45), or no comprehensive care (OR 0.58; 95% CI 0.28 to 1.20; P = 0.14). AUTHORS' CONCLUSIONS There is low quality evidence that medical day hospitals appear effective compared to no comprehensive care for the combined outcome of death or poor outcome, and for deterioration in ADL. There is no clear evidence for other outcomes, or an advantage over other medical care provision.
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Affiliation(s)
- Lesley Brown
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustAcademic Unit of Elderly Care and RehabilitationTemple Bank HouseBradford Royal InfirmaryBradfordUKBD9 6RJ
| | - Anne Forster
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust/University of LeedsAcademic Unit of Elderly Care and RehabilitationTemple Bank House, Bradford Royal InfirmaryDuckworth LaneBradfordUKBD9 6RJ
| | - John Young
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust/University of LeedsAcademic Unit of Elderly Care and RehabilitationTemple Bank House, Bradford Royal InfirmaryDuckworth LaneBradfordUKBD9 6RJ
| | - Tom Crocker
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustAcademic Unit of Elderly Care and RehabilitationTemple Bank HouseBradford Royal InfirmaryBradfordUKBD9 6RJ
| | - Alex Benham
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustAcademic Unit of Elderly Care and RehabilitationTemple Bank HouseBradford Royal InfirmaryBradfordUKBD9 6RJ
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Day Hospital Group
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation TrustAcademic Unit of Elderly Care and RehabilitationTemple Bank HouseBradford Royal InfirmaryBradfordUKBD9 6RJ
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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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Steihaug S, Lippestad JW, Isaksen H, Werner A. Development of a model for organisation of and cooperation on home-based rehabilitation - an action research project. Disabil Rehabil 2013; 36:608-16. [PMID: 23758348 DOI: 10.3109/09638288.2013.800595] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To use general policy guidelines and staff experience of rehabilitation work in two boroughs in Oslo to develop a model for organisation and cooperation in home-based rehabilitation. METHOD The project was conducted as a collaboration between researchers and employees in the two boroughs. It was a practice-oriented study designed as an action research project combining knowledge generation and improvement of practice. Data were collected at seven meetings, and individual, qualitative interviews with a total of 24 persons were conducted in the period February 2010 to June 2011. RESULTS Home-based rehabilitation occurred rarely in the boroughs, and this field received little attention. However, this project provided a broad discussion of rehabilitation involving all parts of the organisation of both boroughs. In the course of the project, researchers and borough staff together developed a model for the organisation of and cooperation on rehabilitation including a coordinating unit assigned the paramount responsibility for the rehabilitation and an interdisciplinary team organising the collaboration on the practical level. CONCLUSIONS When implementing a model like this in primary health services, we recommend involving several levels and service locations of the borough staff in order to legitimise the model in the organisation. IMPLICATIONS FOR REHABILITATION An increasing number of older people with chronic diseases in the Western world have caused increasing emphasis on rehabilitation in primary health care in patients' homes. This study has elucidated challenging framework conditions for rehabilitation work in two Norwegian boroughs. To reduce municipal challenges we propose a rehabilitation model with a coordinating unit with the paramount responsibility for rehabilitation, and an interdisciplinary team constituting a suitable structure for collaboration.
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Turjamaa R, Hartikainen S, Pietilä AM. Forgotten resources of older home care clients: Focus group study in Finland. Nurs Health Sci 2013; 15:333-9. [DOI: 10.1111/nhs.12037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 12/19/2012] [Accepted: 12/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Riitta Turjamaa
- Department of Nursing Science; University of Eastern Finland; Kuopio; Finland
| | - Sirpa Hartikainen
- Research Centre of Geriatric Care; School of Pharmacy; University of Eastern Finland; Kuopio; Finland
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Johansen I, Lindbaek M, Stanghelle JK, Brekke M. Structured community-based inpatient rehabilitation of older patients is better than standard primary health care rehabilitation – an open comparative study. Disabil Rehabil 2012; 34:2039-46. [DOI: 10.3109/09638288.2012.667193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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