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Stoop A, Lette M, van Gils PF, Nijpels G, Baan CA, de Bruin SR. Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e549-e566. [PMID: 31225946 PMCID: PMC6852049 DOI: 10.1111/hsc.12793] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person-centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006-2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty-seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty-one different CGAs were identified, of which the EASYcare instrument, RAI-HC/RAI-CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person-centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter-)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.
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Affiliation(s)
- Annerieke Stoop
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
- Scientific Center for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgthe Netherlands
| | - Manon Lette
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
| | - Paul F. van Gils
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
| | - Giel Nijpels
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
| | - Caroline A. Baan
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Scientific Center for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgthe Netherlands
| | - Simone R. de Bruin
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
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Brett L, Georgiou A, Jorgensen M, Siette J, Scott G, Gow E, Luckett G, Westbrook J. Ageing well: evaluation of social participation and quality of life tools to enhance community aged care (study protocol). BMC Geriatr 2019; 19:78. [PMID: 30871472 PMCID: PMC6419453 DOI: 10.1186/s12877-019-1094-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/26/2019] [Indexed: 01/08/2023] Open
Abstract
Background Several outcome measures can be utilised to measure social participation and Quality of Life (QoL) in research and clinical practice. However there have been few large-scale trials of these tools in community care to identify their value to clients and providers. This study aims to evaluate the implementation of the Australian Community Participation Questionnaire (ACPQ) and the ICEpop CAPability measure for Older people (ICECAP-O) as tools to measure social participation and QoL for clients receiving community aged care services. The specific research questions focus on determining: (1) the levels and predictors of social participation and QoL among older adults using community aged care services; (2) the acceptability and feasibility of implementation of ACPQ and ICECAP-O tools into routine community aged care assessments; (3) if implementation of the tools change service provision and outcomes for older adults receiving community aged care services. Methods A mixed method design will be used to collect data from a large Australian aged care provider. Community aged care clients’ ACPQ and ICECAP-O scores, as well as other key outcomes (e.g. services used, hospitalisation and admission to permanent residential care), will be examined at baseline and 12-monthly follow-up assessments. Interviews and focus groups with community aged care clients and staff who administer the tools will also be completed. Descriptive statistics and multiple linear regression will be used to examine the levels and predictors of social participation and QoL. Thematic analysis of interviews and focus groups will be used to determine the acceptability and feasibility of implementing the ACPQ and ICECAP-O into routine needs assessments in community aged care. Case-controlled analyses will be used to determine whether the implementation of the ACPQ and ICECAP-O changes service use and outcomes. Discussion The novel use of the ACPQ and the ICECAP-O tools as part of routine needs assessments for community aged care clients has the potential to improve the quality and effectiveness of community aged care services and outcomes. Trial registration Australian and New Zealand clinical trial registry number: ACTRN12617001212347. Registered 18/08/2017 Electronic supplementary material The online version of this article (10.1186/s12877-019-1094-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lindsey Brett
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia. .,Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Ground Level, 75 Talavera Raod, Sydney, NSW, 2109, Australia.
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Mikaela Jorgensen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Joyce Siette
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Grace Scott
- School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Edwina Gow
- Uniting, 2 Chapman Avenue, Chatswood, NSW, 2067, Australia
| | - Gemma Luckett
- Centre for Research Innovation and Advocacy, Uniting, 13 Blackwood Place, North Parramatta, NSW, 2151, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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Brettschneider C, Luck T, Fleischer S, Roling G, Beutner K, Luppa M, Behrens J, Riedel-Heller SG, König HH. Cost-utility analysis of a preventive home visit program for older adults in Germany. BMC Health Serv Res 2015; 15:141. [PMID: 25884452 PMCID: PMC4392621 DOI: 10.1186/s12913-015-0817-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most older adults want to live independently in a familiar environment instead of moving to a nursing home. Preventive home visits based on multidimensional geriatric assessment can be one strategy to support this preference and might additionally reduce health care costs, due to the avoidance of costly nursing home admissions. The purpose of this study was to analyse the cost-effectiveness of preventive home visits from a societal perspective in Germany. METHODS This study is part of a multi-centre, non-blinded, randomised controlled trial aiming at the reduction of nursing home admissions. Participants were older than 80 years and living at home. Up to three home visits were conducted to identify self-care deficits and risk factors, to present recommendations and to implement solutions. The control group received usual care. A cost-utility analysis using quality-adjusted life years (QALY) based on the EQ-5D was performed. Resource utilization was assessed by means of the interview version of a patient questionnaire. A cost-effectiveness acceptability curve controlled for prognostic variables was constructed and a sensitivity analysis to control for the influence of the mode of QALY calculation was performed. RESULTS 278 individuals (intervention group: 133; control group: 145) were included in the analysis. During 18 months follow-up mean adjusted total cost (mean: +4,401 EUR; bootstrapped standard error: 3,019.61 EUR) and number of QALY (mean: 0.0061 QALY; bootstrapped standard error: 0.0388 QALY) were higher in the intervention group, but differences were not significant. For preventive home visits the probability of an incremental cost-effectiveness ratio <50,000 EUR per QALY was only 15%. The results were robust with respect to the mode of QALY calculation. CONCLUSIONS The evaluated preventive home visits programme is unlikely to be cost-effective. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT00644826.
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Affiliation(s)
- Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany.
| | - Tobias Luck
- University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health, Leipzig, Germany. .,University of Leipzig, LIFE - Leipzig Research Center for Civilization Diseases, Leipzig, Germany.
| | - Steffen Fleischer
- Martin-Luther-University Halle-Wittenberg, Institute for Health and Nursing Science, Halle, Germany.
| | - Gudrun Roling
- Martin-Luther-University Halle-Wittenberg, Institute for Health and Nursing Science, Halle, Germany. .,Private University of Witten/ Herdecke, Institute for Integrative Medicine (IfIM), Integrated Curriculum for Anthroposophic Medicine (ICURAM), Witten, Germany.
| | - Katrin Beutner
- Martin-Luther-University Halle-Wittenberg, Institute for Health and Nursing Science, Halle, Germany.
| | - Melanie Luppa
- University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health, Leipzig, Germany.
| | - Johann Behrens
- Martin-Luther-University Halle-Wittenberg, Institute for Health and Nursing Science, Halle, Germany. .,German Institute for Economic Research DIW, Berlin, Germany. .,ISIS-Institute for Supervision-, Institutions- and Social Research, Frankfurt a. M, Germany.
| | - Steffi G Riedel-Heller
- University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health, Leipzig, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany.
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Ariss SM, Enderby PM, Smith T, Nancarrow SA, Bradburn MJ, Harrop D, Parker SG, McDonnell A, Dixon S, Ryan T, Hayman A, Campbell M. Secondary analysis and literature review of community rehabilitation and intermediate care: an information resource. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and designThis research was based on a reanalysis of a merged data set from two intermediate care (IC) projects in order to identify patient characteristics associated with outcomes [Nancarrow SA, Enderby PM, Moran AM, Dixon S, Parker SG, Bradburn MJ,et al.The Relationship Between Workforce Flexibility and the Costs and Outcomes of Older Peoples’ Services (COOP). Southampton: National Institute for Health Research (NIHR) Service Delivery and Organisation (SDO); 2010 and Nancarrow SA, Enderby PM, Ariss SM, Smith T, Booth A, Campbell MJ,et al.The Impact of Enhancing the Effectiveness of Interdisciplinary Working (EEICC). Southampton: NIHR SDO; 2012]. Additionally, the impact of different team and staffing structures on patient outcomes and service costs was examined, when possible given the data sets, to enable identification of the most cost-effective service configurations and change over time with service provision. This secondary analysis was placed within updated literature reviews focused on the separate questions.Research objectives(1) To identify those patients most likely to benefit from IC and those who would be best placed to receive care elsewhere; (2) to examine the effectiveness of different models of IC; (3) to explore the differences between IC service configurations and how they have changed over time; and (4) to use the findings above to develop accessible evidence to guide service commissioning and monitoring.SettingCommunity-based services for older people are described in many different ways, among which are IC services and community rehabilitation. For the purposes of this report we call the services IC services and include all community-based provision for supporting older people who would otherwise be admitted to hospital or who would require increased length of stay in hospital (e.g. hospital at home schemes, post-acute care, step-up and step-down services).ParticipantsThe combined data set contained data on 8070 patient admissions from 32 IC teams across England and included details of the service context, costs, staffing/skill mix (800 staff), patient health status and outcomes.InterventionsThe interventions associated with the study cover the range of services and therapies available in IC settings. These are provided by a wide range of professionals and care staff, including nursing, allied health and social care.Outcome measures(1) Service data – each team provided information relating to the size, nature, staffing and resourcing of the services. Data were collected on a service pro forma. (2) Team data – all staff members of the teams participating in both studies provided individual information using the Workforce Dynamics Questionnaire. (3) Patient data – patient data were collected on admission and discharge using a client record pack. The client record pack recorded a range of data utilising a number of validated tools, such as demographic data, level of care (LoC) data, therapy outcome measure (TOM) scale, European Quality of Life-5 Dimensions (EQ-5D) questionnaire and patient satisfaction survey.Results(1) The provision of IC across England is highly variable with different referral routes, team structures, skill mix and cost-effectiveness; (2) in more recent years, patients referred to IC have more complex needs associated with more severe impairments; (3) patients most likely to improve were those requiring rehabilitation as determined by levels 3, 4 and 5 on the LoC (> 40% for impairment, activity and participation, and > 30% for well-being as determined on the TOM scale); (4) half of all patients with outcome data improved on at least one of the domains of the TOM scale; (5) for every 10-year increase in age there was a 6% decrease in the odds of returning home. The chance of remaining or returning home was greater for females than males; (6) a high percentage of patients referred to IC do not require the service; and (7) teams including clinical support staff and domiciliary staff were associated with a small relative improvement in TOM impairment scores when compared with other teams.ConclusionsThis study provides additional evidence that interdisciplinary teamworking in IC may be associated with better outcomes for patients, but care should be taken with overinterpretation. The measures that were used within the studies were found to be reliable, valid and practical and could be used for benchmarking. This study highlights the need for funding high-quality studies that attempt to examine what specific team-level factors are associated with better outcomes for patients. It is therefore important that studies in the future attempt empirically to examine what process-level team variables are associated with these outcomes.FundingThe NIHR Health Services and Delivery Research programme.
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Affiliation(s)
- Steven M Ariss
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Pamela M Enderby
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tony Smith
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Susan A Nancarrow
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Mike J Bradburn
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Deborah Harrop
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Stuart G Parker
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann McDonnell
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Simon Dixon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tony Ryan
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Alexandra Hayman
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Mayo-Wilson E, Grant S, Burton J, Parsons A, Underhill K, Montgomery P. Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis. PLoS One 2014; 9:e89257. [PMID: 24622676 PMCID: PMC3951196 DOI: 10.1371/journal.pone.0089257] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 01/16/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services. METHODS AND FINDINGS DATA SOURCES Ten databases including CENTRAL and Medline searched through December 2012. STUDY SELECTION Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data. Outcomes were pooled using random effects. MAIN OUTCOMES AND MEASURES Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness. RESULTS Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]). There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18]) or hospitalized (RR = 0.96 [0.91 to 1.01]). There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01]), but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = -0.06 [-0.11 to -0.01]) and physical functioning (SMD = -0.10 [-0.17 to -0.03]) respectively, but these may not be clinically important. CONCLUSIONS Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective.
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Affiliation(s)
- Evan Mayo-Wilson
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
| | - Sean Grant
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jennifer Burton
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Amanda Parsons
- Yale Law School, New Haven, Connecticut, United States of America
| | - Kristen Underhill
- Yale Law School, Yale Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, United States of America
| | - Paul Montgomery
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Luck T, Motzek T, Luppa M, Matschinger H, Fleischer S, Sesselmann Y, Roling G, Beutner K, König HH, Behrens J, Riedel-Heller SG. Effectiveness of preventive home visits in reducing the risk of falls in old age: a randomized controlled trial. Clin Interv Aging 2013; 8:697-702. [PMID: 23788832 PMCID: PMC3684143 DOI: 10.2147/cia.s43284] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Falls in older people are a major public health issue, but the underlying causes are complex. We sought to evaluate the effectiveness of preventive home visits as a multifactorial, individualized strategy to reduce falls in community-dwelling older people. Methods Data were derived from a prospective randomized controlled trial with follow-up examination after 18 months. Two hundred and thirty participants (≥80 years of age) with functional impairment were randomized to intervention and control groups. The intervention group received up to three preventive home visits including risk assessment, home counseling intervention, and a booster session. The control group received no preventive home visits. Structured interviews at baseline and follow-up provided information concerning falls in both study groups. Random-effects Poisson regression evaluated the effect of preventive home visits on the number of falls controlling for covariates. Results Random-effects Poisson regression showed a significant increase in the number of falls between baseline and follow-up in the control group (incidence rate ratio 1.96) and a significant decrease in the intervention group (incidence rate ratio 0.63) controlling for age, sex, family status, level of care, and impairment in activities of daily living. Conclusion Our results indicate that a preventive home visiting program can be effective in reducing falls in community-dwelling older people.
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Affiliation(s)
- Tobias Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
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NAZEMI L, SKOOG I, KARLSSON I, HOSSEINI S, HOSSEINI M, HOSSEINZADEH MJ, MOHAMMADI MR, POURANSARI Z, CHAMARI M, BAIKPOUR M. Depression, prevalence and some risk factors in elderly nursing homes in tehran, iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:559-69. [PMID: 23967423 PMCID: PMC3744252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/20/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The most common geriatric psychiatric disorder is depression, known to be a multi factorial disorder. However, the influence of common preventable factors is yet to be discovered. This study was designed to evaluate the prevalence of depression and some possible risk factors in elderly residents of nursing homes in Iran. METHODS Data on demographic characteristics, nutritional and health status of 244 residents aged 60 years or older were collected from seventeen nursing homes in Tehran, Iran, during 2010 to 2012. Depression was assessed and classified according to the 15-item GDS. Univariate and then multivariate complex sample survey ordinal regression analysis was performed to investigate the association between depression and the risk factors. RESULTS The average age of the 244 cases studied was 75.8 (±8.7) years, 53.3% were female (of whom 74.2% were housewives), 43.4% illiterate, and 32.0% were divorced or were living separately. The percentages of non-depressed, mild, moderate and severe depression were 9.8%, 50.0%, 29.5% and 10.7%, respectively. Multivariate analysis showed that dissatisfaction with personnel of nursing homes and food quality had odds ratios of 2.91 (1.33-6.36) and 2.64 (1.44-4.87), corresponding to greater odds of having a higher grade depression. Moreover, those who rested or walked had significantly higher risk of a more severe depression in comparison with those who did not (OR of 2.25 (1.50-3.38) and 1.98 (1.24-3.18), respectively), however, studying had a protective odds ratio of 0.17 (0.13-0.22). CONCLUSION Depression was very common in our sample and their lifestyle influenced its prevalence.
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Affiliation(s)
- Lyly NAZEMI
- Dept. of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Dept. of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran,Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ingmar SKOOG
- Dept. of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unite, Institute of neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ingvar KARLSSON
- Dept. of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unite, Institute of neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Saeed HOSSEINI
- Dept. of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Dept. of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa HOSSEINI
- Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author: Tel: 00982188989125 /
| | - Mohammad Javad HOSSEINZADEH
- Dept. of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Dept. of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza MOHAMMADI
- Psychiatry Research Center, Rozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra POURANSARI
- Dept. of Human Ecology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam CHAMARI
- Dept. of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Dept. of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud BAIKPOUR
- Dept. of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Favela J, Castro LA, Franco-Marina F, Sánchez-García S, Juárez-Cedillo T, Bermudez CE, Mora-Altamirano J, Rodriguez MD, García-Peña C. Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial. Clin Interv Aging 2013; 8:85-95. [PMID: 23378751 PMCID: PMC3558028 DOI: 10.2147/cia.s38618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults. DESIGN Unblinded, randomized, controlled trial. SETTING Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico. PARTICIPANTS Patients were aged over 60 years with a frailty index score higher than 0.14. INTERVENTION After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups. MEASUREMENTS The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered. RESULTS The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group. CONCLUSION An intervention based on NV+AB seems to have a positive effect on frailty scores.
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Affiliation(s)
- Jesús Favela
- Center for Scientific Research and Higher Education of Ensenada, Ensenada, Baja California, Mexico
| | - Luis A Castro
- Sonora Institute of Technology, Ciudad Obregon, Mexico
| | | | - Sergio Sánchez-García
- Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Teresa Juárez-Cedillo
- Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Claudia Espinel Bermudez
- Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Julia Mora-Altamirano
- Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Marcela D Rodriguez
- School of Engineering, MyDCI, Autonomous University of Baja California, Mexicali, Mexico
| | - Carmen García-Peña
- Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
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Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2012; 10:CD009009. [PMID: 23076952 DOI: 10.1002/14651858.cd009009.pub2] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND General health checks are common elements of health care in some countries. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is, therefore, important to assess whether general health checks do more good than harm. OBJECTIVES We aimed to quantify the benefits and harms of general health checks with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes such as blood pressure and serum cholesterol levels. SEARCH METHODS We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE, EMBASE, Healthstar, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) to July 2012. Two authors screened titles and abstracts, assessed papers for eligibility and read reference lists. One author used citation tracking (Web of Knowledge) and asked trialists about additional studies. SELECTION CRITERIA We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening general populations for more than one disease or risk factor in more than one organ system. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias in the trials. We contacted authors for additional outcomes or trial details when necessary. For mortality outcomes we analysed the results with random-effects model meta-analysis, and for other outcomes we did a qualitative synthesis as meta-analysis was not feasible. MAIN RESULTS We included 16 trials, 14 of which had available outcome data (182,880 participants). Nine trials provided data on total mortality (155,899 participants, 11,940 deaths), median follow-up time nine years, giving a risk ratio of 0.99 (95% confidence interval (CI) 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (152,435 participants, 4567 deaths), risk ratio 1.03 (95% CI 0.91 to 1.17) and eight trials on cancer mortality (139,290 participants, 3663 deaths), risk ratio 1.01 (95% CI 0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings.We did not find an effect on clinical events or other measures of morbidity but one trial found an increased occurrence of hypertension and hypercholesterolaemia with screening and one trial found an increased occurence of self-reported chronic disease. One trial found a 20% increase in the total number of new diagnoses per participant over six years compared to the control group. No trials compared the total number of prescriptions, but two out of four trials found an increased number of people using antihypertensive drugs. Two out of four trials found small beneficial effects on self-reported health, but this could be due to reporting bias as the trials were not blinded. We did not find an effect on admission to hospital, disability, worry, additional visits to the physician, or absence from work, but most of these outcomes were poorly studied. We did not find useful results on the number of referrals to specialists, the number of follow-up tests after positive screening results, or the amount of surgery. AUTHORS' CONCLUSIONS General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased. Important harmful outcomes, such as the number of follow-up diagnostic procedures or short term psychological effects, were often not studied or reported and many trials had methodological problems. With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial.
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