Case managed community aged care: what is the evidence for effects on service use and costs?

Impact of community care services on the health of older adults: evidence from China

Introduction

The rapid growth in the population of older adults has put tremendous pressure on medical and social services in countries including China. Community care services are a feasible solution for promoting healthy aging in developing countries. This study investigated the association between community care services and the health of older adults in China.

Method

Using nationally representative survey data from China, consisting of four waves conducted in 2005, 2008, 2011, and 2014, a balanced panel dataset was constructed using a sample of 4,700 older adults (33.1% aged 80 years or older, 51.0% residing in rural areas, and 48.8% women). We employed linear regression models with time-fixed effects and instrumental variable approaches to estimate the effect of community care services on the health of older adults, as well as the differences in these effects across subgroups.

Results

The results showed that community care services lead to a significant improvement in both the objective and subjective health and wellbeing of older adults. Among the various service offerings, spiritual recreation services led to a significant increase in both objective and subjective health scores, while medical care services significantly improved wellbeing. This suggests a varied effect of subdivided service types. Further evidence suggests that spiritual recreation services have a significant health-enhancing effect on multiple groups of older adults, and the effect of medical care services is more effective for those living in rural areas, women, and those who are older than 80 years (all p < 0.05).

Discussion

Few studies have examined the impact of community care services on the health of older adults in developing countries. The findings present important implications for improving the health status of older adults and provide suggestions for establishing a socialized aged care system in China.

Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review

OBJECTIVE

To identify the relationships between the context in which integrated care programmes (ICPs) for community-dwelling frail older people are applied, the mechanisms by which the programmes do (not) work and the outcomes resulting from this interaction by establishing a programme theory.

DESIGN

Rapid realist review.

INCLUSION CRITERIA

Reviews and meta-analyses (January 2013-January 2019) and non-peer-reviewed literature (January 2013-December 2019) reporting on integrated care for community-dwelling frail older people (≥60 years).

ANALYSIS

Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards criteria. Data on context, mechanisms, programme activities and outcomes were extracted. Factors were categorised into the five strategies of the WHO framework of integrated people-centred health services (IPCHS).

RESULTS

27 papers were included. The following programme theory was developed: it is essential to establish multidisciplinary teams of competent healthcare providers (HCPs) providing person-centred care, closely working together and communicating effectively with other stakeholders. Older people and informal caregivers should be involved in the care process. Financial support, efficient use of information technology and organisational alignment are also essential. ICPs demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and HCPs, and a delayed placement in a nursing home. Heterogeneous effects were found for hospital-related outcomes, quality of life, healthcare costs and use of healthcare services. The two most prevalent WHO-IPCHS strategies as part of ICPs are 'creating an enabling environment', followed by 'strengthening governance and accountability'.

CONCLUSION

Currently, most ICPs do not address all WHO-IPCHS strategies. In order to optimise ICPs for frail older people the interaction between context items, mechanisms, programme activities and the outcomes should be taken into account from different perspectives (system, organisation, service delivery, HCP and patient).

Proactive primary care model for frail older people in New Zealand delays aged-residential care: A quasi-experiment

BACKGROUND/OBJECTIVES

To determine the effect of a proactive primary care program on acute hospitalization and aged-residential care placement for frail older people.

DESIGN

Controlled before and after, and controlled after only quasi-experimental studies, with a comparison group created via propensity score matching. One-year follow-up.

SETTING

Nine general practices in Auckland, New Zealand.

PARTICIPANTS

Community-dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks.

INTERVENTION

Primary healthcare based, registered nurse-led, comprehensive geriatric assessment, goal-setting, care planning, and regular follow-up. Patients were also provided self-management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists.

MEASUREMENTS

Outcomes from routinely collected administrative data. Primary: aged-residential care placement.

SECONDARY OUTCOMES

acute hospitalization, mortality, and other health service utilization.

RESULTS

Aged-residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48-0.91) and mortality (OR 0.66, 95% CI = 0.49-0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = -0.01-0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased.

CONCLUSION

The Kare participants had lower aged-residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.

Health and health service usage outcomes of case management for patients with long-term conditions: a review of reviews

Objective:

There have been plenty of articles published in recent decades on patient care in the form of case management (CM), but conclusions regarding health outcomes and costs have often been discordant. The objective of this study was to examine previous systematic reviews and meta-analyses with a view to assessing and pooling the overwhelming amount of data available on CM-based health outcomes and resource usage.

Methods:

We conducted a review of reviews of secondary studies (meta-analyses and systematic reviews) addressing the effectiveness of CM compared with usual care (or other organizational models) in adult (18+) with long-term conditions. PubMed, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects (DARE) were searched from 2000 to the end of December 2017. The outcomes of interest are related to process of care, health measures, and resource usage.

Results:

Twenty-two articles were ultimately considered: 4 meta-analyses and 18 systematic reviews. There is strong evidence of CM increasing adherence to treatment guidelines and improving patient satisfaction, but none of the secondary studies considered demonstrated any effect on patient survival. Based on the available literature, there is contrasting evidence regarding all the other health outcomes, such as quality of life (QOL), clinical outcomes, and functional status. Good-quality secondary studies consistently found nothing to indicate that CM prompts any reduction in the use of hospital resources.

Conclusion:

The source of variability in the literature on the consistency of the evidence for most outcomes is unclear. It may stem from the heterogeneity of CM programs in terms of what their intervention entails, the populations targeted, and the tools used to measure the results. That said, there was consistently strong evidence of CM being associated with a greater adherence to treatment guidelines and higher patient satisfaction, but not with a longer survival or better use of hospital resources.

Interventions to Prevent or Delay Long-Term Nursing Home Placement for Adults with Impairments-a Systematic Review of Reviews

BACKGROUND

With continued growth in the older adult population, US federal and state costs for long-term care services are projected to increase. Recent policy changes have shifted funding to home and community-based services (HCBS), but it remains unclear whether HCBS can prevent or delay long-term nursing home placement (NHP).

METHODS

We searched MEDLINE (OVID), Sociological Abstracts, PsycINFO, CINAHL, and Embase (from inception through September 2018); and Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database, AHRQ Evidence-based Practice Center, and VA Evidence Synthesis Program reports (from inception through November 2018) for English-language systematic reviews. We also sought expert referrals. Eligible reviews addressed HCBS for community-dwelling adults with, or at risk of developing, physical and/or cognitive impairments. Two individuals rated quality (using modified AMSTAR 2) and abstracted review characteristics, including definition of NHP and interventions. From a prioritized subset of the highest-quality and most recent reviews, we abstracted intervention effects and strength of evidence (as reported by review authors).

RESULTS

Of 47 eligible reviews, most focused on caregiver support (n = 10), respite care and adult day programs (n = 9), case management (n = 8), and preventive home visits (n = 6). Among 20 prioritized reviews, 12 exclusively included randomized controlled trials, while the rest also included observational studies. Prioritized reviews found no overall benefit or inconsistent effects for caregiver support (n = 2), respite care and adult day programs (n = 3), case management (n = 4), and preventive home visits (n = 2). For caregiver support, case management, and preventive home visits, some reviews highlighted that a few studies of higher-intensity models reduced NHP. Reviews on other interventions (n = 9) generally found a lack of evidence examining NHP.

DISCUSSION

Evidence indicated no benefit or inconsistent effects of HCBS in preventing or delaying NHP. Demonstration of substantial impacts on NHP may require longer-term studies of higher-intensity interventions that can be adapted for a variety of settings. Registration PROSPERO # CRD42018116198.

Effects of 'participatory group-based care management' on wellbeing of older people living alone: a randomized controlled trial

BACKGROUND AND OBJECTIVES

More knowledge is needed of the effectiveness of complex interventions that aim to promote the wellbeing of older people. This study examines the effects of 'participatory group-based care management' conducted among community-dwelling older adults living alone in Central and Eastern Finland. The intervention aimed to promote wellbeing and quality of life (QoL) using a needs-based and participatory approach.

METHODS

The study was carried out as a randomized control trial (intervention group n = 185, control group n = 207). In this article, baseline and 6-month follow-up surveys were used. QoL (WHOQOL-Bref instrument), loneliness (Revised UCLA Loneliness Scale; single-item question), and trust (two items of generalized trust and six items of institutional trust) were used as outcome measurements, and generalized estimating equations (GEE) modeling as the analysis method. Both per-protocol and intention-to-treat analyses were applied.

RESULTS

According to the per-protocol analysis, the intervention had no effects on QoL. Loneliness decreased among older people with poor QoL at the baseline. Additionally, the intervention enhanced trust in other people and some dimensions of institutional trust. The intention-to-treat analysis did not result in any significant effects on QoL or loneliness, but some small positive changes in institutional trust were found.

CONCLUSIONS

Based on some evidence of small positive effects, the intervention may be beneficial in alleviating loneliness and enhancing trust among older people living alone. Because of the contradictory results, more research is needed to examine the complexity of 'participatory group-based care management´ from the perspective of process evaluation.

Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis

Background

Flexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.

Aim

To conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.

Objectives

(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?

Data sources

Searches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.

Design

Mapping review and rapid, systematic evidence syntheses.

Setting

Care homes with and without nursing in high-income countries.

Review methods

Published literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.

Results

Seven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.

Limitations

This review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.

Conclusions

This review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.

Future work

Future work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.

Study registration

This study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Service Delivery Models to Maximize Quality of Life for Older People at the End of Life: A Rapid Review

Policy Points We identified two overarching classifications of integrated geriatric and palliative care to maximize older people's quality of life at the end of life. Both are oriented to person-centered care, but with differing emphasis on either function or symptoms and concerns. Policymakers should both improve access to palliative care beyond just the last months of life and increase geriatric care provision to maintain and optimize function. This would ensure that continuity and coordination for potentially complex care needs across the continuum of late life would be maintained, where the demarcation of boundaries between healthy aging and healthy dying become increasingly blurred. Our findings highlight the urgent need for health system change to improve end-of-life care as part of universal health coverage. The use of health services should be informed by the likelihood of benefits and intended outcomes rather than on prognosis.

CONTEXT

In an era of unprecedented global aging, a key priority is to align health and social services for older populations in order to support the dual priorities of living well while adapting to a gradual decline in function. We aimed to provide a comprehensive synthesis of evidence regarding service delivery models that optimize the quality of life (QoL) for older people at the end of life across health, social, and welfare services worldwide.

METHODS

We conducted a rapid scoping review of systematic reviews. We searched MEDLINE, CINAHL, EMBASE, and CDSR databases from 2000 to 2017 for reviews reporting the effectiveness of service models aimed at optimizing QoL for older people, more than 50% of whom were older than 60 and in the last one or two years of life. We assessed the quality of these included reviews using AMSTAR and synthesized the findings narratively.

RESULTS

Of the 2,238 reviews identified, we included 72, with 20 reporting meta-analysis. Although all the World Health Organization (WHO) regions were represented, most of the reviews reported data from the Americas (52 of 72), Europe (46 of 72), and/or the Western Pacific (28 of 72). We identified two overarching classifications of service models but with different target outcomes: Integrated Geriatric Care, emphasizing physical function, and Integrated Palliative Care, focusing mainly on symptoms and concerns. Areas of synergy across the overarching classifications included person-centered care, education, and a multiprofessional workforce. The reviews assessed 117 separate outcomes. A meta-analysis demonstrated effectiveness for both classifications on QoL, including symptoms such as pain, depression, and psychological well-being. Economic analysis and its implications were poorly considered.

CONCLUSIONS

Despite their different target outcomes, those service models classified as Integrated Geriatric Care or Integrated Palliative Care were effective in improving QoL for older people nearing the end of life. Both approaches highlight the imperative for integrating services across the care continuum, with service involvement triggered by the patient's needs and likelihood of benefits. To inform the sustainability of health system change we encourage economic analyses that span health and social care and examine all sources of finance to understand contextual inequalities.

Case Management Effectiveness on Health Care Utilization Outcomes: A Systematic Review of Reviews

Case management is a cost-effective strategy for coordinating chronic illness care. However, research showing how case management affects health care is mixed. This study systematically synthesizes and critically evaluates evidence in systematic reviews of health care utilization outcomes from case management interventions for the care of chronic illnesses. Results are synthesized from seven English language systematic reviews published between January 1990 and June 2017. Hospital readmissions, length of hospital stay, institutionalization, emergency department visits, and hospitals/primary care visits were all identified as health care utilization outcomes of case management interventions. There was evidence that these interventions positively reduced health care utilization; however, results were mixed. These results and the implications of this review of reviews may be valuable for clinical practitioners, health care researchers, and policymakers.

Case management effectiveness for managing chronic illnesses in Korea: a systematic review

BACKGROUND

Case management has been adopted in Korea and been recognized as a promising care-coordination method that lowers costs and improves quality of care. However, the effectiveness of case management among individuals with chronic illnesses who reside in the community has yet to be established.

AIM

This systematic review identifies and synthesizes recent evidence of case management's effectiveness in managing chronic illnesses among adults in Korea.

METHODS

The methodology of this systematic review was guided by the Cochrane processes and PRISMA statements. A search of multiple bibliographic databases to identify studies of case management in the populations of Koreans adult with chronic illnesses was conducted. Studies that met the inclusion criteria were published in English or Korean. Nine empirical peer-reviewed studies published between 2008 and 2016 were selected for review.

RESULTS

The retrieved studies show that case management programmes in Korea for adults with chronic illness in the community were led by nurses. There was strong evidence that nurse-led case management was effective in improving psychobehavioural and objective clinical outcomes; however, results for health services utilization outcomes were mixed.

CONCLUSION

In future, research with rigorous study designs and large sample size in multiple settings are needed to further assess the effectiveness of case management in Korea.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse-led case management would be of support in the care of chronic illnesses not only in Korea but also in Asian countries which share standard practice of case management with Korea. Nursing leaders should allocate resources to sponsor educational resources and practical strategies for evidence-based case management.

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

INTRODUCTION

There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services.

OBJECTIVES

We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration.

METHODS

Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange.

RESULTS

Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system.

CONCLUSIONS

There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews

Background

Many elders struggle with the decision to remain at home or to move to an alternative location of care. A person’s location of care can influence health and wellbeing. Healthcare organizations and policy makers are increasingly challenged to better support elders’ dwelling and health care needs. A summary of the evidence that examines home care compared to other care locations can inform decision making. We surveyed and summarized the evidence evaluating the impact of home care versus alternative locations of care on elder health outcomes.

Methods

We conducted an overview of systematic reviews. Data sources included MEDLINE, the Cochrane Library, EMBASE, and CINAHL. Eligible reviews included adults 65+ years, elder home care, alternative care locations, and elder health outcomes. Two independent reviewers screened citations. We extracted data and appraised review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. Results were synthesized narratively.

Results

The search yielded 2575 citations, of which 19 systematic reviews were eligible. Three hundred and forty studies with 271,660 participants were synthesized across the systematic reviews. The categories of comparisons included: home with support versus independent living at home (n = 11 reviews), home care versus institutional care (n = 3 reviews), and rehabilitation at home versus conventional rehabilitation services (n = 7 reviews). Two reviews had data relevant to two categories. Most reviews favoured home with support to independent living at home. Findings comparing home care to institutional care were mixed. Most reviews found no differences in health outcomes between rehabilitation at home versus conventional rehabilitation services. Systematic review quality was moderate, with a median AMSTAR score of 6 (range 4 - 10 out of 11).

Conclusions

The evidence on the impact of home care compared to alternative care locations on elder health outcomes is heterogeneous. Our findings support positive health impacts of home support interventions for community dwelling elders compared to independent living at home. There is insufficient evidence to determine the impact of alternative care locations on elders’ health. Additional research targeting housing and care options for the elderly is needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0395-y) contains supplementary material, which is available to authorized users.

Influences on Case-Managed Community Aged Care Practice

Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.

Hospitalisation of older people before and after long-term care entry in Auckland, New Zealand

INTRODUCTION

global population projections forecast large growth in demand for long-term care (LTC) and acute hospital services for older people. Few studies report changes in hospitalisation rates before and after entry into LTC. This study compares hospitalisation rates 1 year before and after LTC entry.

METHODS

the Older Persons' Ability Level (OPAL) study was a 2008 census-type survey of LTC facilities in Auckland, New Zealand. OPAL resident hospital admissions and deaths were obtained from routinely collected national databases.

RESULTS

all 2,244 residents (66% = female) who entered LTC within 12 months prior to OPAL were included. There were 3,363 hospitalisations, 2,424 in 12 months before and 939 in 12 months after entry, and 364 deaths. In the 6 to 12 months before LTC entry, the hospitalisation rate/100 person-years was 67.3 (95% confidence interval [CI] 62.5-72.1). Weekly rates then rose steeply to over 450/100 person-years in the 6 months immediately before LTC entry. In the 6 months after LTC entry, the rate fell to 49.1 (CI 44.9-53.3; RR 0.73 (CI 0.65-0.82, P < 0.0001)) and decreased further 6 to 12 months after entry to 41.1 (CI 37.1-45.1; rate ratio [RR] 0.61 (CI 0.54-0.69, P < 0.0001)).

CONCLUSIONS

increased hospitalisations a few months before LTC entry suggest functional and medical instability precipitates LTC entry. New residents utilise hospital beds less frequently than when at home before that unstable period. Further research is needed to determine effective interventions to avoid some hospitalisations and possibly also LTC entry.

How do case managers spend time on their functions and activities?

BACKGROUND

Case management has been a widely accepted approach to practice in various care settings. This study aimed to explore how community aged care case managers allocated their time to case management functions, how frequently they performed specific case management activities, and what factors influenced the frequency of their activities.

METHODS

The study involved 154 survey participants, or 17.1% of the target case managers in the State of Victoria, Australia. Key information collected included participants' socio-demographic characteristics, proportions of time allocated to six core case management functions, and frequency ratings of 41 specific activities within seven case management functions. Ordinal regression analyses were performed to determine significant factors associated with participants' frequency ratings of their activities.

RESULTS

Participants allocated the largest proportion of time to care coordination (22.0%), and the smallest proportion of time to outcome evaluation (8.0%). Over 70% of the participants assigned high frequency ratings to 31 of the 41 case management activities. The remaining ten activities, including all four outcome evaluation activities, three needs assessment activities, one care planning activity, one care coordination activity, and one general functions-related activity were less commonly performed very frequently. The regression analyses indicated that some case manager and client factors were significantly associated with frequency ratings of nine of the ten activities aforementioned. The two main findings of the regression analyses were: First, emphasising achieving more case management goals was significantly associated with higher frequency of three outcome evaluation activities; second, longer work experience was significantly associated with higher frequency of one care coordination activity and one outcome evaluation activity.

CONCLUSIONS

The frequent performance of most case management activities and relative absence of factors influencing their frequency suggest a uniformity of practice in community aged care case managers' practice. What is not clear is whether the frequency of these activities (in particular less frequent performance of outcome evaluation activities) conforms to expectations.

Case management for frail older adults through tablet computers and Skype

BACKGROUND

Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication.

OBJECTIVE

This paper examines frail older adults' use of tablet computers and Skype, with their case managers.

METHOD

Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data.

RESULTS

The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use.

CONCLUSION

Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further.

Cost-utility analysis of case management for frail older people: effects of a randomised controlled trial

BACKGROUND

To evaluate the effects of a case management intervention for frail older people (aged 65+ years) by cost and utility.

MATERIALS AND METHODS

One hundred and fifty-three frail older people living at home were randomly assigned to either an intervention (n = 80) or a control group (n = 73). The 1-year intervention was carried out by nurses and physiotherapists working as case managers, who undertook home visits at least once a month. Differences in costs and quality-adjusted life years (QALYs) based on the health-related quality-of-life instruments EQ-5D and EQ-VAS, and also the incremental cost-effectiveness ratio were investigated. All analyses used the intention-to-treat principle.

RESULTS

There were no significant differences between the intervention group and control group for total cost, EQ-5D-based QALY or EQ-VAS-based QALY for the 1-year study. Incremental cost-effectiveness ratio was not conducted because no significant differences were found for either EQ-5D- or EQ-VAS-based QALY, or costs. However, the intervention group had significantly lower levels of informal care and help with instrumental activities of daily living both as costs (<euro>3,927 vs. <euro>6,550, p = 0.037) and provided hours (200 vs. 333 hours per year, p = 0.037).

CONCLUSIONS

The intervention was cost neutral and does not seem to have affected health-related quality of life for the 1-year study, which may be because the follow-up period was too short. The intervention seems to have reduced hours and cost of informal care and help required with instrumental activities of daily living. This suggests that the intervention provides relief to informal caregivers.

A Descriptive Analysis of Incidents Reported by Community Aged Care Workers

Little is known about the types of incidents that occur to aged care clients in the community. This limits the development of effective strategies to improve client safety. The objective of the study was to present a profile of incidents reported in Australian community aged care settings. All incident reports made by community care workers employed by one of the largest community aged care provider organizations in Australia during the period November 1, 2012, to August 8, 2013, were analyzed. A total of 356 reports were analyzed, corresponding to a 7.5% incidence rate per client year. Falls and medication incidents were the most prevalent incident types. Clients receiving high-level care and those who attended day therapy centers had the highest rate of incidents with 14% to 20% of these clients having a reported incident. The incident profile indicates that clients on higher levels of care had higher incident rates. Incident data represent an opportunity to improve client safety in community aged care.