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Fret B, Smetcoren AS, De Donder L, Verté D. Preventive Home Visits Among Frail Community-Dwelling Older Adults. The Added Value of Follow-Up Telephone Calls. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:444-457. [PMID: 38491960 DOI: 10.1080/19371918.2024.2325555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
People in need of care and support do not always find appropriate services. This paper aims to explore the content and added value of monthly follow-up telephone calls after preventive home visits. We used both monitoring data and qualitative semi-structured interviews (with older adults, formal and informal caregivers). Results indicate that a majority of older adults (N = 95) received a regular follow-up of four telephone calls. Social connection and involvement were mentioned by all three groups as positive aspects of the program. Although time-consuming, this paper draws attention to the added value of follow-up telephone calls after preventive home visits.
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Affiliation(s)
- Bram Fret
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - An-Sofie Smetcoren
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Liesbeth De Donder
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dominique Verté
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Ramli DB, Shahar S, Mat S, Ibrahim N, Tohit NM. The effectiveness of preventive home visits on resilience and health-related outcomes among community dwelling older adults: A systematic review. PLoS One 2024; 19:e0306188. [PMID: 38950029 PMCID: PMC11216600 DOI: 10.1371/journal.pone.0306188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/11/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND This research aimed to assess the effectiveness of preventive home visits (PHVs) in enhancing resilience and health-related outcomes among older adults living in the community. METHODS A comprehensive literature search was conducted in nine databases (PubMed, MEDLINE, CINAHL, Embase, Emcare, Web of Science (WOS), Scopus, PsycINFO and Cochrane Library. The search was undertaken between March 15 and 31, 2022 with subsequent updates performed on October 15, 2023 and April 10, 2024. This review also included grey literature sourced via Google, Google Scholar and backward citation searches. RESULTS Out of 5,621 records, 20 articles were found to meet the inclusion criteria with a total of 8,035 participants involved and the mean age ranged from 74.0 to 84.4 years. Using McMaster Critical Review Form for Quantitative Studies, we ascertained that the studies included in our analysis had moderate to high levels of quality. In addition to health-related outcomes, PHV interventions were also conducted to evaluate psychological effects (16 studies) and social outcomes (seven studies). Five studies conducted financial assessment to evaluate the costs of health and social care utilisation during PHV interventions. Regarding the results of the review, seven studies showed favourable outcomes, five indicated no effect and eight had equivocal findings. Only one study assessed resilience and determined that PHV had no effect on the resilience of the subjects. CONCLUSION This review found that the effectiveness of PHV interventions was uncertain and inconclusive. PHV interventions often prioritise health-related objectives. The incorporation of a holistic approach involving psychosocial health into PHV interventions is relatively uncommon. Due to the paucity of research on resilience as PHV outcome, we are unable to draw a conclusion on the effectiveness of PHV on resilience. Resilience should be prioritised as a psychological assessment in the future development of comprehensive PHV interventions, as it enables older adults to adapt, manage, and respond positively to adversities that may arise with age. Performing financial analysis such as costs and benefits analysis to incorporate the return on investment of PHV interventions is an added value for future research on this topic. CLINICAL TRIAL REGISTRATION PROSPERO registration number: CRD42022296919.
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Affiliation(s)
- Dayang Balkis Ramli
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Public Service Department, Prime Minister’s Office, Putrajaya, Malaysia
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan, Bangi, Malaysia
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Balqis-Ali NZ, Jawahir S, Chan YM, Lim AWY, Azlan UW, Shaffie SSM, Fun WH, Lee SWH. The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews. BMC Geriatr 2024; 24:484. [PMID: 38831269 PMCID: PMC11145838 DOI: 10.1186/s12877-024-05097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND As the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons. METHODS A scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE. RESULTS Thirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality. CONCLUSION The findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.
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Affiliation(s)
- Nur Zahirah Balqis-Ali
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia.
| | - Yee Mang Chan
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Amanda Wei-Yin Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Ummi Wahidah Azlan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Sal Sabila Mohd Shaffie
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus Malaysia, Subang Jaya, Selangor, Malaysia
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Johansen LW, Lausund H, Jøranson N. Health Professionals' Experiences with Health-Promoting Dialogues for Older Home-Dwellers-A Qualitative Study. Behav Sci (Basel) 2024; 14:464. [PMID: 38920796 PMCID: PMC11200546 DOI: 10.3390/bs14060464] [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: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Home-dwelling older people without healthcare services might develop vulnerability and health-related issues that should be detected proactively by service providers. Health-promoting measures directed towards the target group could facilitate living longer and better at home, as well as delay the need for healthcare services. One approach is through health-promoting dialogues between the municipality and healthcare professionals. This study aims to explore the experiences of healthcare professionals involved in health-promoting dialogues with home-dwellers aged over 75 years without health service decisions in Norway. Data were collected through three focus groups. Thematic analysis was applied to the data resulting in the emergence of one major theme, "challenging dialogues", comprising three sub-themes: "promote the individual's perspectives", "uncovering vulnerability", and "ambiguity of the dialogues". The health-promoting dialogue uses a resource perspective for the elderly to remain independent in old age and can reveal vulnerability and underlying needs. The purpose of the dialogue appears ambiguous for the target group, which leads to unclear service expectations and frequent rejections of the offer. Nevertheless, this health-promoting service has a clear purpose of identifying and meeting the needs of the target group in a broader sense during the ageing process.
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Affiliation(s)
| | | | - Nina Jøranson
- Faculty of Health Sciences, VID Specialized University, 0319 Oslo, Norway; (L.W.J.); (H.L.)
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Novotni G, Taneska M, Novotni A, Fischer J, Iloski S, Ivanovska A, Dimitrova V, Novotni L, Milutinović M, Joksimoski B, Chorbev I, Hasani S, Dogan V, Grimmer T, Kurz A. North Macedonia interprofessional dementia care (NOMAD) - personalized care plans for people with dementia and caregiver psychoeducation delivered at home by interprofessional teams. FRONTIERS IN DEMENTIA 2024; 3:1391471. [PMID: 39081604 PMCID: PMC11285573 DOI: 10.3389/frdem.2024.1391471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/13/2024] [Indexed: 08/02/2024]
Abstract
Introduction The increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia. Method We conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates. Results One hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [-4.75, -0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [-19.74, -2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [-2.61, -1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention's acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia. Discussion The trial showed that it is effective in reducing caregivers' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.
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Affiliation(s)
- Gabriela Novotni
- Department of Cognitive Neurology and Neurodegenerative Diseases, University Clinic of Neurology, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Marija Taneska
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Antoni Novotni
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
- University Clinic of Psychiatry, Skopje, North Macedonia
| | - Julia Fischer
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Svetlana Iloski
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Andrea Ivanovska
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Vesna Dimitrova
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | - Miloš Milutinović
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
- University Clinic of Psychiatry, Skopje, North Macedonia
| | - Boban Joksimoski
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Ivan Chorbev
- Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Shpresa Hasani
- Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Vildan Dogan
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Timo Grimmer
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
| | - Alexander Kurz
- Department for Psychiatry and Psychotherapy, Center for Cognitive Disorders, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany
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Palapar L, Blom JW, Wilkinson-Meyers L, Lumley T, Kerse N. Preventive interventions to improve older people's health outcomes: systematic review and meta-analysis. Br J Gen Pract 2024; 74:e208-e218. [PMID: 38499364 PMCID: PMC10962503 DOI: 10.3399/bjgp.2023.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/04/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Systematic reviews of preventive, non-disease-specific primary care trials for older people often report effects according to what is thought to be the intervention's active ingredient. AIM To examine the effectiveness of preventive primary care interventions for older people and to identify common components that contribute to intervention success. DESIGN AND SETTING A systematic review and meta-analysis of 18 randomised controlled trials (RCTs) published in 22 publications from 2009 to 2019. METHOD A search was conducted in PubMed, MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and the Cochrane Library. Inclusion criteria were: sample mainly aged ≥65 years; delivered in primary care; and non-disease-specific interventions. Exclusion criteria were: non-RCTs; primarily pharmacological or psychological interventions; and where outcomes of interest were not reported. Risk of bias was assessed using the original Cochrane tool. Outcomes examined were healthcare use including admissions to hospital and aged residential care (ARC), and patient-reported outcomes including activities of daily living (ADLs) and self-rated health (SRH). RESULTS Many studies had a mix of patient-, provider-, and practice-focused intervention components (13 of 18 studies). Studies included in the review had low-to-moderate risk of bias. Interventions had no overall benefit to healthcare use (including admissions to hospital and ARC) but higher basic ADL scores were observed (standardised mean difference [SMD] 0.21, 95% confidence interval [CI] = 0.01 to 0.40) and higher odds of reporting positive SRH (odds ratio [OR] 1.17, 95% CI = 1.01 to 1.37). When intervention effects were examined by components, better patient-reported outcomes were observed in studies that changed the care setting (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.17, 95% CI = 1.01 to 1.37), included educational components for health professionals (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.27, 95% CI = 1.05 to 1.55), and provided patient education (SMD for basic ADLs 0.28, 95% CI = 0.09 to 0.48). Additionally, admissions to hospital in intervention participants were fewer by 23% in studies that changed the care setting (incidence rate ratio [IRR] 0.77, 95% CI = 0.63 to 0.95) and by 26% in studies that provided patient education (IRR 0.74, 95% CI = 0.56 to 0.97). CONCLUSION Preventive primary care interventions are beneficial to older people's functional ability and SRH but not other outcomes. To improve primary care for older people, future programmes should consider delivering care in alternative settings, for example, home visits and phone contacts, and providing education to patients and health professionals as these may contribute to positive outcomes.
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Affiliation(s)
- Leah Palapar
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Thomas Lumley
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Karunananthan S, Hakimjavadi R, Konnyu K. Maintaining independence in older adults. BMJ 2024; 384:q592. [PMID: 38514071 DOI: 10.1136/bmj.q592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Sathya Karunananthan
- Interdisciplinary School of Health Sciences, University of Ottawa, ON K1N 6N5, Canada
| | | | - Kristin Konnyu
- Health Services Research Unit, University of Aberdeen, UK
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Meulenbroeks I, Mercado C, Gates P, Nguyen A, Seaman K, Wabe N, Silva SM, Zheng WY, Debono D, Westbrook J. Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review. BMC Geriatr 2024; 24:75. [PMID: 38243175 PMCID: PMC10799511 DOI: 10.1186/s12877-023-04624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Preventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings. METHODS Five databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool. RESULTS One-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included 'exercise' (61%, n = 65), 'multifactorial' (two or more intervention types delivered together) (26%, n = 28), and 'vitamin D' (18%, n = 19). In RAC and community settings, 'exercise' interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. 'Multifactorial' interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. 'Vitamin D' interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively). CONCLUSION 'Exercise' interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting 'exercise' interventions to become 'multifactorial' interventions may also improve the incidence of falls in both settings.
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Affiliation(s)
- Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia.
| | - Crisostomo Mercado
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Peter Gates
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Amy Nguyen
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Karla Seaman
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Sandun M Silva
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
| | - Wu Yi Zheng
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Deborah Debono
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia
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Björkstedt E, Voutilainen A, Auvinen K, Hyttinen V, Jyrkkä J, Mäntyselkä P, Lönnroos E. The role of functioning in predicting nursing home placement or death among older home care patients. Scand J Prim Health Care 2023; 41:478-485. [PMID: 37916677 PMCID: PMC11001308 DOI: 10.1080/02813432.2023.2274333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. DESIGN A prospective one-year follow-up study. SETTINGS AND SUBJECTS Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). MAIN OUTCOME MEASURES Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). RESULTS Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62-0.86), IADL (0.75, 0.65-0.87) MMSE (0.92, 0.87-0.96), and TUG (1.02, 1.01-1.03). NHP alone was predicted by BADL (0.62, 0.50-0.78), IADL (0.57, 0.45-0.73), and MMSE (0.88, 0.82-0.94) and mortality by TUG (1.02, 1.01-1.03). CONCLUSION Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.
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Affiliation(s)
- Eeva Björkstedt
- Department of Primary Health Care, Wellbeing Services County of South Savo, Mikkeli, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kati Auvinen
- Department of Primary Health Care, Wellbeing Services County of South Savo, Mikkeli, Finland
| | - Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Johanna Jyrkkä
- Information and Development Services Unit, Finnish Medicines Agency FIMEA, Kuopio, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Clinical Research and Trials Centre, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Soldado-Matoses MS, Caplliure-Llopis J, Barrios C. Effectiveness of a home health monitoring and education program for complex chronic patients, led by primary care nurses. Front Public Health 2023; 11:1281980. [PMID: 38026405 PMCID: PMC10665850 DOI: 10.3389/fpubh.2023.1281980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background The challenge of chronicity has led developed countries to design strategies to respond to the new needs of complex chronic patients (CCP). There is evidence supporting better beneficial effects and more efficient care for CCP when home-base care programs are provided by Primary Health Care professionals. The main objective of the present study was to assess the effectiveness of a nursing intervention program of home visits for CCP analyzing the use of health services in terms of hospital admissions, emergency care unit visits, and mortality rate. Methods A quasi-experimental study was designed to retrospectively evaluate the effectiveness of a 3-year proactive, individualized nursing intervention in improving health outcomes measured by health service utilization (hospitalization, emergency care, and nursing home visits) in these patients. Of the 344 complex chronic patients participating in the study, 93 were assigned to the intervention group (IG) and 251 to the control group (CG). Results Along the period of study, the number of home visits in the IG almost tripled in relation to the CG (14.29 ± 4.49 vs. 4.17 ± 2.68, p < 0.001). Admissions in the first and second year of the study period were lower in the intervention group p = 0.002 and p < 0.001 respectively. All the participants in the control group were admitted at least once during the study period. In contrast, 29.0% of the participants in the intervention group never had a hospital admission during the 3-years study period. The number of ED visits to the emergency department was significantly lower in the IG during the 3 years of the study periods. The cumulative number of emergency visits in the IG was half that in the CG (5.66 ± 4. vs. 11.11 ± 4.45, p < 0.001, Cohen'd,1.53). A total of 35.5% of the participants in the intervention group visited the emergency department on three or fewer occasions compared to 98% of the subjects in the control group who visited the emergency department on more than six occasions (p < 0.001). The 3-year overall mortality rate was 23.5% in the control group and 21.6% in the nursing home visit program. These differences were not statistically significant. Conclusion The program demonstrated its effectiveness in reduction of hospital admissions and visits to the emergency department. The program had no impact on mortality rate. This program of home visits reinforces the role of primary care nurses in advanced competencies in chronicity.
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Affiliation(s)
- María S. Soldado-Matoses
- School of Doctorate, University of Valencia Saint Vincent Martyr, Valencia, Spain
- Department of Health La Ribera, Valencia, Spain
| | - Jordi Caplliure-Llopis
- Department of Nursing, School of Medicine and Health Sciences, Catholic University of Valencia Saint Vincent Martyr, Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Catholic University of Valencia Saint Vincent Martyr, Valencia, Spain
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Hasegawa K, Tsukahara T, Nomiyama T. Associations between long-term care-service use and service- or care-need level progression: a nationwide cohort study using the Japanese Long-Term Care Insurance Claims database. BMC Health Serv Res 2023; 23:577. [PMID: 37277778 DOI: 10.1186/s12913-023-09615-0] [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: 12/06/2022] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The effectiveness of the long-term care service in Japan has been unclear, and most of the relevant studies of this service have been limited to a single region and relatively small samples, necessitating large-scale studies. We examined the associations between long-term care service use and the service/care-need level progression at the national scale in Japan. METHODS We conducted a nationwide retrospective cohort study using data from the Japanese Long-Term Care Insurance Claims database. Individuals aged ≥ 65 years and newly certified as being at the support-need level 1 or 2 or the care-need level 1 between April 2012 and March 2013 were included. We first conducted 1:1 propensity score matching and then examined the associations between service use and the progression in support-need or care-need levels by using Kaplan-Meier survival curves and log-rank tests. RESULTS The final sample consisted of 332,766 individuals. We observed that service use was associated with a faster decline in the support/care-need level, although the differences in the subjects' survival rate diminished; the log-rank test showed significance (p < 0.001). When stratified for urban-rural classifications or regions of Japan, the results were similar to the primary analysis in all of the stratified groups, and no clear regional variations were observed. CONCLUSION We did not observe a clear beneficial effect of receiving long-term care in Japan. Our results suggest that Japan's current long-term care service may not be effective for the recipients of these services. Considering that the system is becoming a financial burden, a re-examination of the service to provide more cost-effective care may be advisable.
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Affiliation(s)
- Kohei Hasegawa
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Teruomi Tsukahara
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Department of Occupational Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tetsuo Nomiyama
- Department of Preventive Medicine and Public Health, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Department of Occupational Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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12
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Ambagtsheer RC, Thompson MQ, Tucker GR, Schultz T, Beilby J, Visvanathan R. Does CGA Improve Health Outcomes in the Community? An Umbrella Review. J Am Med Dir Assoc 2023:S1525-8610(23)00297-9. [PMID: 37088103 DOI: 10.1016/j.jamda.2023.03.018] [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: 12/06/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES To perform an umbrella review of systematic reviews with meta-analyses (MAs) examining the effectiveness of comprehensive geriatric assessment (CGA) delivered within community settings to general populations of community-dwelling older people against various health outcomes. DESIGN Umbrella review of MAs of randomized controlled trials (RCTs). SETTING AND PARTICIPANTS Systematic reviews with MAs examining associations between CGA conducted within the community and any health outcome, where participants were community-dwelling older people with a minimum mean age of 60 years or where at least 50% of study participants were aged ≥60 years. Studies focusing on residential care, hospitals, post-hospital care, outpatient clinics, emergency department, or patients with specific conditions were excluded. METHODS We examined CGA effectiveness against 12 outcomes: not living at home, nursing home admission, activities of daily living (ADLs) and instrumental ADLs (IADLs), physical function, falls, self-reported health status, quality of life, frailty, mental health, hospital admission, and mortality, searching the MEDLINE/PubMed, Cochrane Library, CINAHL, Embase databases from January 1, 1999, to August 10, 2022. AMSTAR-2 was used to assess the quality of included systematic reviews, including risk of bias. RESULTS We identified 10 MAs. Only not living at home (combined mortality and nursing home admission) demonstrated concordance between effect direction, significance, and magnitude. Significant effects were more typically observed in earlier rather than later studies. CONCLUSION AND IMPLICATIONS Given the widespread adoption of CGA as a component of usual care within geriatric medicine, the lack of strong evidence demonstrating the protective effects of CGA may be indicative of a cohort effect. If so, future RCTs examining CGA effectiveness are unlikely to demonstrate significant findings. Future studies of CGA in the community should focus on implementation and adherence to key components. TRIAL REGISTRATION Study protocol registered in PROSPERO 2020 CRD42020169680.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Torrens University Australia, South Australia, Australia.
| | - Mark Q Thompson
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Graeme R Tucker
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia
| | - Timothy Schultz
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Flinders Health and Medical Research Institute, Flinders University, South Australia, Australia
| | - Justin Beilby
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Torrens University Australia, South Australia, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence: Frailty and Healthy Ageing, University of Adelaide, South Australia, Australia; Adelaide Geriatrics Training & Research with Aged Care (G-TRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
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13
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Eltaybani S, Kawase K, Kato R, Inagaki A, Li CC, Shinohara M, Igarashi A, Sakka M, Sumikawa Y, Fukui C, Yamamoto-Mitani N. Effectiveness of home visit nursing on improving mortality, hospitalization, institutionalization, satisfaction, and quality of life among older people: Umbrella review. Geriatr Nurs 2023; 51:330-345. [PMID: 37060618 DOI: 10.1016/j.gerinurse.2023.03.018] [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: 11/22/2022] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/17/2023]
Abstract
This umbrella review followed the JBI methodology and synthesized systematic reviews of the effectiveness of long-term home visit nursing for older people (≥ 60 years) on improving mortality, hospitalization, institutionalization, patient satisfaction, and quality of life. Eight bibliographic databases were searched, and 10 reviews with 22 distinct relevant trials (n = 10,765 participants) were included. Mortality was the most frequently examined outcome and satisfaction was the least examined (n = nine and one reviews, respectively). Home visit nursing had a favorable effect on reducing the number of admissions to hospital (n = 1,152 participants in two trials vs. 788 participants in three trials) and no effect on other outcomes. The evidence of the effectiveness of long-term home visit nursing for older people is minimal. Future research needs to be based on a theoretical foundation that explains how interventions are expected to work.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Global Nursing Research center (GNRC), The University of Tokyo, Tokyo, Japan.
| | - Kiyomi Kawase
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Risako Kato
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Asa Inagaki
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chia-Chien Li
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Masumi Shinohara
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Ayumi Igarashi
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Mariko Sakka
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Yuka Sumikawa
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Chie Fukui
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Homecare and Long-Term Care Nursing, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Ergin E, Akin B, Kocoglu-Tanyer D. Effect of Home Visits by Nurses on the Physical and Psychosocial Health of Older Adults: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:733-745. [PMID: 35936539 PMCID: PMC9288399 DOI: 10.18502/ijph.v51i4.9234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
Background One of the best ways to maintain and develop physical and psychosocial health is to make regular home visits. This meta-analysis aimed to determine (by subgroups) the effects of interventions based on nurses' home visits on physical and psychological health outcomes of older people. Methods This search was carried out using the The CINAHL, Cochrane, MEDLINE, PubMed, Science Direct, Web of Science, and Turkish databases. Experimental and observational studies were included. Results The meta-analysis included 26 (with subgroups 50) out of 13110 studies. The minimum and maximum values of the effect size (Hedges g) were g = -0.708 and g = 0.525, respectively. The average effect size was g = 0.084 (SD = 0.21). Conclusion Home visit interventions are effective in reducing the frequency of hospitalization in the older adults, and improving physical and psychosocial health. They are negatively effective on falls and have no significant effect on the quality of life.
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Affiliation(s)
- Emine Ergin
- Department of Public Health Nursing, Faculty of Health Sciences, İstanbul Aydın University, İstanbul, Turkey
| | - Belgin Akin
- Department of Public Health Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
| | - Deniz Kocoglu-Tanyer
- Department of Public Health Nursing, Faculty of Nursing, Selcuk University, Konya, Turkey
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15
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Lord S, Teh R, Gibson R, Smith M, Wrapson W, Thomson M, Rolleston A, Neville S, McBain L, Del Din S, Taylor L, Kayes N, Kingston A, Abey-Nesbit R, Kerse N. Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand. BMC Geriatr 2022; 22:215. [PMID: 35296250 PMCID: PMC8925165 DOI: 10.1186/s12877-022-02845-7] [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: 09/29/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanāu (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing. METHODS Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whānau (family) centred initiative (Ngā Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum. DISCUSSION AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age. TRIAL REGISTRATION The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875 ).
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Affiliation(s)
- Sue Lord
- School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
| | - Ruth Teh
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rosie Gibson
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Wendy Wrapson
- AUT Public Health and Mental Health Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Murray Thomson
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | | | - Stephen Neville
- School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | | | - Silvia Del Din
- Clinical Ageing Research Unit, Newcastle University, Newcastle Upon Tyne, UK
| | - Lynne Taylor
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nicola Kayes
- School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Rebecca Abey-Nesbit
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Department of Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Ngaire Kerse
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Burgos Díez C, Sequera Requero RM, Ferrer Costa J, Tarazona-Santabalbina FJ, Monzó Planella M, Cunha-Pérez C, Santaeugènia González SJ. Study of a Quasi-Experimental Trial to Compare Two Models of Home Care for the Elderly in an Urban Primary Care Setting in Spain: Results of Intermediate Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2329. [PMID: 35206517 PMCID: PMC8872333 DOI: 10.3390/ijerph19042329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
Functional dependence is associated with an increase in need for resources, mortality, and institutionalization. Different models of home care have been developed to improve these results, but very few studies contain relevant information. This quasi-experimental study was conducted to evaluate two models of home care (HC) in a Primary Care setting: an Integrated Model (IM) (control model) and a Functional Model (FM) (study model). MATERIAL AND METHODS Two years follow-up of patients 65 years old and older from two Primary Health Care Centres (58 IM, 68 FM) was carried out, recruited between June-October 2018 in Badalona (Barcelona, Spain). Results of the mid-term evaluation are presented in this article. Health status, quality of care, and resource utilization have been evaluated through comprehensive geriatric assessment, quality of life and perception of health care scales, consumption of resources and complementary tests. RESULTS A significant difference was detected in the number of hospital admissions (FM/IM 0.71 (1.24)/1.35 (1.90), p: 0.031) in the Accident and Emergency department (FM/IM 2.01 (2.12)/3.53 (3.59), p: 0.006) and cumulative days of admission per year (FM/IM 5.43 (10.92)/14.69 (20.90), p: 0.003). CONCLUSIONS FM offers greater continuity of care at home for the patient and reduces hospital admissions, as well as admission time, thereby saving on costs.
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Affiliation(s)
- Carolina Burgos Díez
- Primary Health Care Centre Passeig Maragall, Institut Català de la Salut, 08041 Barcelona, Spain;
| | | | - Jose Ferrer Costa
- Primary Health Care Centre Apenins, Badalona Serveis Assistencials, 08917 Badalona, Spain;
| | - Francisco José Tarazona-Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, 46600 Alzira, Spain;
- Medical School, Catholic University of Valencia, Sant Vicent Màrtir, 46001 Valencia, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
| | - Marià Monzó Planella
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain;
| | - Cristina Cunha-Pérez
- Faculty of Nursing, Catholic University of Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Sebastià Josep Santaeugènia González
- Central Catalonia Chronicity Research Group (C3RG), University of Vic, Central University of Catalonia, 08500 Vic, Spain
- Chronic Care Program, Ministry of Health, Generalitat de Catalunya, 08028 Barcelona, Spain
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Tay YL, Abu Bakar NS, Tumiran R, Ab Rahman NH, Mohd Ma'amor NAA, Yau WK, Abdullah Z. Effects of home visits on quality of life among older adults: a systematic review protocol. Syst Rev 2021; 10:307. [PMID: 34872589 PMCID: PMC8650292 DOI: 10.1186/s13643-021-01862-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Home visiting services for older adults have been offered for decades to maintain and promote health and independent functioning, thus enhancing quality of life. Previous systematic reviews have provided a mixed picture of the benefits of home visiting programmes in older adults, primarily because of heterogeneity in study designs, targeted populations, and intervention strategies. These reviews may also become out of date; thus, an updated synthesis of relevant studies is warranted. Our objective is to perform a systematic review of recently published primary studies on the effectiveness of multi-professional home visits on quality of life among older adults. METHODS We will perform a comprehensive search for studies investigating the effect of a multi-professional home visit approach on quality of life among older adults. We will conduct the literature search in selected electronic databases and relevant research websites from January 2010 onwards. We will include randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies that enrolled older adults without dementia over 60 years old, along with studies involving multi-professional preventive-promotive home visit approaches not related to recent hospital discharge. We will report our planned review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will retrieve and record relevant data in a standardised data extraction form and evaluate the quality of the included articles using the Cochrane risk of bias tool and the quality assessment tool for studies with diverse designs (QATSDD). Where appropriate, outcomes will be pooled for meta-analysis using a random-effects model. The main outcomes include quality of life, incidence of falls, depression, dementia, and emergency department admissions. DISCUSSION This review may provide evidence for the effectiveness of home visits in improving older adults' quality of life. It will potentially benefit health care professionals, policymakers, and researchers by facilitating the design and delivery of interventions related to older generations and improve service delivery in future. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021234531 .
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Affiliation(s)
- Yea Lu Tay
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia.
| | - Nurul Salwana Abu Bakar
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia
| | - Ruzimah Tumiran
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia
| | - Noor Hasidah Ab Rahman
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia
| | | | - Weng Keong Yau
- General Medical Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Zalilah Abdullah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, 40170, Shah Alam, Selangor, Malaysia
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Nivestam A, Haak M, Westergren A, Petersson P. Give Older Persons a Voice in the Society-By Using Information Compiled during Preventive Home Visits on a Societal Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147433. [PMID: 34299882 PMCID: PMC8306987 DOI: 10.3390/ijerph18147433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
Abstract
Preventive home visits (PHVs) are offered to older persons with the purpose of promoting health and preventing risks on an individual level. However, aspects of health need to be considered on a societal level as well. This study aims to get a deeper understanding of perceptions of the usability of the information compiled during the PHVs to promote health, among older persons, on a societal level. Three online focus groups were conducted with heads of unit of PHVs, heads of department, and politicians responsible for health and welfare in seven municipalities in Sweden (n = 12). The findings were visualised in the core category Enable an inclusive society and the interrelated categories Monitoring determinants of health and Enabling exchange of information. The information from the PHVs could be used to monitor determinants of health by identifying assets, challenges, shifts, trends, and future needs in the society. Moreover, exchange of information from the PHVs could occur within and outside the health and welfare organisation. However, the potential use was affected by hindrances illustrated in the category Obstacles to interpreting and communicating the information. To conclude, using the information from the PHVs could possibly contribute to an inclusive society, where persons not usually represented in decision making are given a voice.
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Affiliation(s)
- Anna Nivestam
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (M.H.); (A.W.); (P.P.)
- Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00 Lund, Sweden
- Correspondence:
| | - Maria Haak
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (M.H.); (A.W.); (P.P.)
- Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00 Lund, Sweden
| | - Albert Westergren
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (M.H.); (A.W.); (P.P.)
- Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00 Lund, Sweden
| | - Pia Petersson
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (M.H.); (A.W.); (P.P.)
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Kristiansen M, Nedergaard Jensen A, Norredam M, Srivarathan A. Targeting preventive home visits to older adults in disadvantaged communities: Perspectives of professionals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1051-1060. [PMID: 32794327 DOI: 10.1111/hsc.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/10/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
This study explored the implementation of multidimensional preventive home visits targeted to older adults living in a disadvantaged community in Denmark. The intervention was adapted to include the following key components: involvement of community members in recruitment processes; a combination of individual and group-based dissemination; adaptation of materials to overcome language barriers; and diversity-sensitivity training for professionals. The study took place over 12 months between August 2016 and August 2017 and used various data sources: registry-based data, participant observations, combined with individual and focus group interviews with the target population (n = 22) and relevant health care professionals (n = 8). Here, we report on findings pertaining to implementation barriers and facilitators as seen from the perspective of professionals. Socioeconomic vulnerability was prominent, and uptake of health care services was low, indicating under-utilisation. Implementation facilitators and barriers were identified including potentials in nurturing local partnerships and proximity during recruitment; overcoming language barriers; offering diversity-sensitivity training for professionals; and a need for a more multidisciplinary, comprehensive scope of preventive visits for diverse older adults in disadvantaged communities. Thus, more focus on participatory, comprehensive and community-based health promotion are needed to ensure healthy ageing in the context of social inequality and ethnic diversity.
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Affiliation(s)
- Maria Kristiansen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Andrea Nedergaard Jensen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Abirami Srivarathan
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
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Neumann L, Dapp U, Böttcher-Völker S, Kleinhans E, von Renteln-Kruse W. [The "Hamburg home visit for older citizens" : Development, execution and acceptance in 4716 older people in 15 months]. Z Gerontol Geriatr 2021; 54:471-478. [PMID: 33796892 DOI: 10.1007/s00391-021-01878-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/10/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Preventive home visits are part of communal programs for older citizens. The city of Hamburg promoted the pilot project "The Hamburg home visit for older citizens" in two city districts. The voluntary program is offered to persons on their 80th birthday, without comprehensive assessment and is performed by visitors with a background in healthcare or social work. The aim is to provide information, to identify need of help and to initiate contact with officials for support if wanted. METHODS The structural and administrative prerequisites were defined together with officials of the city of Hamburg and the two city districts. The data safety concept, provision of addresses, birthday letter, information to be provided, recruitment, qualification and training of the visitors, timing and performance of visits, guiding how to communicate during the home visit, documentation and quarterly reports are described in detail. RESULTS From September 2018 to December 2019, 1636 (35%) out of 4716 persons contacted were visited by 59 visitors. The most frequent reasons for refusal were no need because of good health (40%) or satisfaction with existing support (14%). Most issues addressed were health situation (51%), mobility (43%), housing conditions (42%) and social contacts (41%). There was need of support as documented in 399 out of 1636 home visits, and contacts for support were initiated as required by 55 persons. CONCLUSION The acceptance of this new approach was 10% higher than 25% per month that had been expected in both the concentrated urban as well as the more rural city districts. Home visits on the 80th birthday appear to be feasible provided that structural and operational prerequisites are considered. In 2020, they were offered to all districts of the city, i.e. to about 15,000 persons per year.
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Affiliation(s)
- Lilli Neumann
- Forschungsabteilung, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg, Sellhopsweg 18-22, 22459, Hamburg, Deutschland.
| | - Ulrike Dapp
- Forschungsabteilung, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg, Sellhopsweg 18-22, 22459, Hamburg, Deutschland
| | - Silke Böttcher-Völker
- Behörde für Gesundheit und Verbraucherschutz (bis 30.06.2020), Freie und Hansestadt Hamburg, Billstraße 80, 20539, Hamburg, Deutschland
| | - Elisabeth Kleinhans
- Behörde für Gesundheit und Verbraucherschutz (bis 30.06.2020), Freie und Hansestadt Hamburg, Billstraße 80, 20539, Hamburg, Deutschland
| | - Wolfgang von Renteln-Kruse
- Forschungsabteilung, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wissenschaftliche Einrichtung an der Universität Hamburg, Sellhopsweg 18-22, 22459, Hamburg, Deutschland
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Bajraktari S, Sandlund M, Zingmark M. Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context. ACTA ACUST UNITED AC 2020; 78:97. [PMID: 33072316 PMCID: PMC7556574 DOI: 10.1186/s13690-020-00480-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/06/2020] [Indexed: 01/09/2023]
Abstract
Background Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries. Methods This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O′Malley’s framework, and the Medical Research Council’s (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus. Results Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors. Conclusions All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are ‘Senior meetings’, ‘preventive home visits’ and ‘exercise interventions’ on its own or combined with other components.
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Affiliation(s)
- Saranda Bajraktari
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Magnus Zingmark
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.,Department of Epidemiology and Public Health, Umeå University, Umeå, Sweden
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La Grouw Y, Bannink D, van Hout H. Care Professionals Manage the Future, Frail Older Persons the Past. Explaining Why Frailty Management in Primary Care Doesn't Always Work. Front Med (Lausanne) 2020; 7:489. [PMID: 32984375 PMCID: PMC7485521 DOI: 10.3389/fmed.2020.00489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/17/2020] [Indexed: 12/25/2022] Open
Abstract
Frailty management focuses on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention in primary care. Such care programs demand a joint effort by primary care professionals and older persons, one in which professionals are expected to promote or facilitate self-management practices and older persons are expected to adhere to the professional advice. It is known that patients and professionals hold different perspectives on frailty, but we know little about how this may affect their cooperation in frailty management. In this article, we therefore study how different perspectives of older persons and their primary care professionals play a role frailty management in practice. Nine cases of frailty management were reconstructed through semi-structured interviews with older persons, their family doctor and practice nurse. Drawing from literature on managing complex problems, we analyzed how "factual" and "normative" orientations played a role in their perspectives. We observe that the perspectives of care professionals and older persons on frailty management were substantially different. Both actors "manage" frailty, but they focus on different aspects of frailty and interestingly, care professionals' rationale is future-oriented whereas older person's rationale past-oriented. Primary care professionals employed practices to manage the medical and social factors of frailty in order to prevent future loss. Older persons employed practices to deal with the psychological, emotional and social aspects of the different types of loss they already experienced, in order to reconcile with loss from the past in the present. These findings raise fundamental questions regarding the different perceptions of and priorities around not only care for frail older people in general, but also implied professional-patient relations and the value of a risk-management approach to care for older people with frail health. The distinction between these perspectives could help care professionals to better respond to older patients' preferences and it could empower older persons to voice preferences and priorities that might not fit within the proposed care program.
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Affiliation(s)
- Yvonne La Grouw
- Department of Political Science & Public Administration, Faculty of Social Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Duco Bannink
- Department of Political Science & Public Administration, Faculty of Social Sciences, VU University Amsterdam, Amsterdam, Netherlands
| | - Hein van Hout
- Departments of General Practice & Medicine of older people, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
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Duan-Porter W, Ullman K, Rosebush C, McKenzie L, Ensrud KE, Ratner E, Greer N, Shippee T, Gaugler JE, Wilt TJ. Interventions to Prevent or Delay Long-Term Nursing Home Placement for Adults with Impairments-a Systematic Review of Reviews. J Gen Intern Med 2020; 35:2118-2129. [PMID: 31898134 PMCID: PMC7352002 DOI: 10.1007/s11606-019-05568-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Wei Duan-Porter
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA.
- University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Kristen Ullman
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Christina Rosebush
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lauren McKenzie
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Edward Ratner
- University of Minnesota Medical School, Minneapolis, MN, USA
- Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Tetyana Shippee
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
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Lette M, Boorsma M, Lemmens L, Stoop A, Nijpels G, Baan C, de Bruin S. Unknown makes unloved-A case study on improving integrated health and social care in the Netherlands using a participatory approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:670-680. [PMID: 31773803 PMCID: PMC7028071 DOI: 10.1111/hsc.12901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/04/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the process of improving an existing integrated care initiative in the Netherlands. Using a participatory approach, researchers and local stakeholders collaborated to develop and implement activities to further improve collaboration between health and social care professionals. Improvement activities included interprofessional meetings focussing on reflection and mutual learning and workplace visits. Researchers evaluated the improvement process, using data triangulation of multiple qualitative and quantitative data sources. According to participating professionals, the improvement activities improved their communication and collaboration by establishing mutual understanding and trust. Enabling factors included the safe and informal setting in which the meetings took place and the personal relationships they developed during the project. Different organisational cultures and interests and a lack of ownership and accountability among managers hindered the improvement process, whereas issues such as staff shortages, time constraints and privacy regulations made it difficult to implement improvements on a larger scale. Still, the participatory approach encouraged the development of partnerships and shared goals on the level of both managers and professionals. This case study highlights that improving communication between professionals is an important first step in improving integrated care. In addition, it shows that a participatory approach, in which improvements are co-created and tailored to local priorities and needs, can help in the development of shared goals and trust between stakeholders with different perspectives. However, stakeholders' willingness and ability to participate in such an improvement process is challenged by many factors.
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Affiliation(s)
- Manon Lette
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Marijke Boorsma
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
| | - Lidwien Lemmens
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Annerieke Stoop
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMC – VU University AmsterdamAmsterdamThe Netherlands
| | - Caroline Baan
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgThe Netherlands
| | - Simone de Bruin
- Centre for Nutrition, Prevention and Health Services ResearchNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
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Abbott RA, Moore DA, Rogers M, Bethel A, Stein K, Coon JT. Effectiveness of pharmacist home visits for individuals at risk of medication-related problems: a systematic review and meta-analysis of randomised controlled trials. BMC Health Serv Res 2020; 20:39. [PMID: 31941489 PMCID: PMC6961241 DOI: 10.1186/s12913-019-4728-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Medication reviews by community pharmacists aim to maximise therapeutic benefit but also minimise harm. Pharmacist-led medication reviews have been the focus of several systematic reviews, but none have focussed on the home setting. Review methods To determine the effectiveness of pharmacist home visits for individuals at risk of medication-related problems we undertook a systematic review and meta-analysis of randomised controlled trials (RCTs). Thirteen databases were searched from inception to December 2018. Forward and backward citation of included studies was also performed. Articles were screened for inclusion independently by two reviewers. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Data extraction and quality appraisal were performed by one reviewer and checked by a second. Random-effects meta-analyses were performed where sufficient data allowed and narrative synthesis summarised all remaining data. Results Twelve RCTs (reported in 15 articles), involving 3410 participants, were included in the review. The frequency, content and purpose of the home visit varied considerably. The data from eight trials were suitable for meta-analysis of the effects on hospital admissions and mortality, and from three trials for the effects on quality of life. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 1.01 (95%CI 0.86 to 1.20, I2 = 69.0%, p = 0.89; 8 studies, 2314 participants)), or mortality (RR of 1.01 (95%CI 0.81 to 1.26, I2 = 0%, p = 0.94; 8 studies, 2314 participants)). There was no consistent evidence of an effect on quality of life, medication adherence or knowledge. Conclusion A systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life. Future studies should focus on using more robust methods to assess relevant outcomes.
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Affiliation(s)
- Rebecca A Abbott
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Darren A Moore
- Graduate School of Education, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Morwenna Rogers
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Alison Bethel
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Ken Stein
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Jo Thompson Coon
- Evidence Synthesis Team, PenCLAHRC University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
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Franse CB, Zhang X, van Grieken A, Rietjens J, Alhambra-Borrás T, Durá E, Garcés-Ferrer J, van Staveren R, Rentoumis T, Markaki A, Bilajac L, Vasiljev Marchesi V, Rukavina T, Verma A, Williams G, Clough G, Koppelaar E, Martijn R, Mattace Raso F, Voorham AJJ, Raat H. A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components. J Adv Nurs 2019; 75:3689-3701. [PMID: 31441529 DOI: 10.1111/jan.14181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/19/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Abstract
AIMS To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. DESIGN Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. METHODS The UHCE approach intervention consisted of a preventive assessment, shared decision-making on a care plan and enrolment in one or more of four coordinated care-pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. RESULTS Having limited function was associated with non-enrolment in falls and loneliness care-pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. CONCLUSIONS Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. IMPACT Coordinated preventive care approaches for older community-dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care. TRIAL REGISTRATION ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.
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Affiliation(s)
- Carmen B Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xuxi Zhang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Estrella Durá
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | | | | | | | | | - Lovorka Bilajac
- Faculty of Medicine, Department of Social Medicine and Epidemiology, University of Rijeka, Rijeka, Croatia.,Teaching Institute of Public Health Primorsko-Goranska County, Rijeka, Croatia
| | - Vanja Vasiljev Marchesi
- Faculty of Medicine, Department of Social Medicine and Epidemiology, University of Rijeka, Rijeka, Croatia.,Faculty of Health Studies, Department of Public Health, University of Rijeka, Rijeka, Croatia
| | - Tomislav Rukavina
- Faculty of Medicine, Department of Social Medicine and Epidemiology, University of Rijeka, Rijeka, Croatia.,Teaching Institute of Public Health Primorsko-Goranska County, Rijeka, Croatia
| | - Arpana Verma
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Greg Williams
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Gary Clough
- Manchester Urban Collaboration on Health, Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Elin Koppelaar
- Research Centre Innovation in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Rens Martijn
- Research Centre Innovation in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Francesco Mattace Raso
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antonius J J Voorham
- Research Centre Innovation in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Continuity of care interventions for preventing hospital readmission of older people with chronic diseases: A meta-analysis. Int J Nurs Stud 2019; 101:103396. [PMID: 31698168 DOI: 10.1016/j.ijnurstu.2019.103396] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospital readmission after discharge is a frequent, burdensome and costly event, particularly frequent in older people with multiple chronic conditions. Few literature reviews have analysed studies of continuity of care interventions to reduce readmissions of older inpatients discharged home over the short and long term. OBJECTIVE To evaluate the effectiveness of continuity of care interventions in older people with chronic diseases in reducing short and long term hospital readmission after hospital discharge. DESIGN Meta-analysis of randomized controlled trials. DATA SOURCES A comprehensive literature search on the databases PubMed, Medline, CINAHL and EMBASE was performed on 27 January 2019 with no language and time limits. REVIEW METHODS RCTs on continuity of care interventions on older people discharged from hospital having hospital readmission as outcome, were included. Two reviewers independently screened the studies and assessed methodological quality using the Cochrane Risk of Bias tool. Selected outcome data were combined and pooled using a Mantel-Haenszel random-effects model. RESULTS Thirty RCTs, representing 8920 patients were included. Results were stratified by time of readmissions. At 1 month from discharge, the continuity interventions were associated with lower readmission rates in 207/1595 patients in the experimental group (12.9%), versus 264/1645 patients in the control group (16%) (Relative Risk [RR], 0.84 [95% CI, 0.71-0.99]). From 1 to 3 months, readmission rates were lower in 325/1480 patients in the experimental group (21.9%), versus 455/1523 patients in the control group (29.8%) (RR 0.74 [95% CI, 0.65-0.84]). A subgroup analysis showed that this positive effect was stronger when the interventions addressed all of the continuity dimensions. After 3 months this impact became inconclusive with moderate/high statistical heterogeneity. CONCLUSIONS Continuity of care interventions prevent short term hospital readmission in older people with chronic diseases. However, there is inconclusive evidence about the effectiveness of continuity interventions aiming to reduce long term readmission, and it is suggested that stronger focus on it is needed.
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The evidence for services to avoid or delay residential aged care admission: a systematic review. BMC Geriatr 2019; 19:217. [PMID: 31395018 PMCID: PMC6686247 DOI: 10.1186/s12877-019-1210-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/11/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Interventions that enable people to remain in their own home as they age are of interest to stakeholders, yet detailed information on effective interventions is scarce. Our objective was to systematically search and synthesise evidence for the effectiveness of community-based, aged care interventions in delaying or avoiding admission to residential aged care. METHOD Nine databases were searched from January 2000 to February 2018 for English publications. Reference lists of relevant publications were searched. The databases yielded 55,221 citations and 50 citations were gleaned from other sources. Where there was sufficient homogeneity of study design, population, intervention and measures, meta-analyses were performed. Studies were grouped by the type of intervention: complex multifactorial interventions, minimal/single focus interventions, restorative programs, or by the target population (e.g. participants with dementia). RESULTS Data from 31 randomised controlled trials (32 articles) that met our inclusion criteria were extracted and analysed. Compared to controls, complex multifactorial interventions in community aged care significantly improved older adults' ability to remain living at home (risk difference - 0.02; 95% CI -0.03, - 0.00; p = 0.04). Commonalities in the 13 studies with complex interventions were the use of comprehensive assessment, regular reviews, case management, care planning, referrals to additional services, individualised interventions, frequent client contact if required, and liaison with General Practitioners. Complex interventions did not have a significantly different effect on mortality. Single focus interventions did not show a significant effect in reducing residential aged care admissions (risk difference 0, 95% CI -0.01, 0.01; p = 0.71), nor for mortality or quality of life. Subgroup analysis of complex interventions for people with dementia showed significant risk reduction for residential aged care admissions (RD -0.05; 95% CI -0.09, -0.01; p = 0.02). Compared to controls, only interventions targeting participants with dementia had a significant effect on improving quality of life (SMD 3.38, 95% CI 3.02, 3.74; p < 0.000001). CONCLUSIONS Where the goal is to avoid residential aged care admission for people with or without dementia, there is evidence for multifactorial, individualised community programs. The evidence suggests these interventions do not result in greater mortality and hence are safe. Minimal, single focus interventions will not achieve the targeted outcomes. TRIAL REGISTRATION PROSPERO Registration CRD42016050086 .
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Choi NG, Sullivan JE, Marti CN. Low-income homebound older adults receiving home-delivered meals: Physical and mental health conditions, incidence of falls and hospitalisations. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e406-e416. [PMID: 30892773 DOI: 10.1111/hsc.12741] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/21/2019] [Accepted: 02/20/2019] [Indexed: 06/09/2023]
Abstract
Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low-income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self-reported falls and hospitalisations among largely low-income and racial/ethnic minority adults age 50+ (N = 2,224), clients from a home-delivered meals programme in Central Texas. Data came from comprehensive, in-home assessments done in 2017 by these older adults' case managers. We used bivariate analyses to compare those with and without incidence of self-reported past-year falls and those with and without a hospitalisation episode with respect to their sociodemographic and clinical characteristics. We used multivariable logistic regression analysis to examine sociodemographic and clinical correlates of any incidence of falls and negative binomial regression analysis to examine these correlates of the number of hospitalisations in the preceding 12 months. The rates of chronic physical illnesses, including cardiovascular disease, diabetes, gastrointestinal disease, lung disease and renal failure, were extremely high. The 41% of reported falls among the study sample was also higher than the rate among US older adults in general. More diagnosed physical illnesses, depression, chewing/swallowing problems, chronic/severe pain, activities and instrumental activities of daily living (ADL/IADL) impairments and ambulation assistive device use were associated with greater odds of falling. The rate of past-year hospitalisation was 26%, and more diagnosed physical illnesses, ADL/IADL impairments, ambulation assistive device use and any fall incidence were positively associated with the number of hospitalisations. These findings indicate the need for fall prevention programmes for frail homebound older adults as well as health and social care services that help older adults better manage physical/mental health problems and reduce preventable health crises and hospitalisations.
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Affiliation(s)
- Namkee G Choi
- University of Texas at Austin Steve Hicks School of Social Work, Austin, Texas
| | - John E Sullivan
- University of Texas at Austin Steve Hicks School of Social Work, Austin, Texas
| | - C Nathan Marti
- University of Texas at Austin Steve Hicks School of Social Work, Austin, Texas
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Liimatta HA, Lampela P, Kautiainen H, Laitinen-Parkkonen P, Pitkala KH. The Effects of Preventive Home Visits on Older People’s Use of Health Care and Social Services and Related Costs. J Gerontol A Biol Sci Med Sci 2019; 75:1586-1593. [DOI: 10.1093/gerona/glz139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We use data from a randomized controlled trial on preventive home visits exploring effectiveness on health-related quality of life. In this article, we examine the intervention’s cost-effectiveness and effects on quality-adjusted life years in older home-dwelling adults.
Methods
There were 422 independently home-dwelling participants in the randomized, controlled trial, all aged more than 75 years, with equal numbers in the control and intervention groups. The intervention took place in a municipality in Finland and consisted of multiprofessional preventive home visits. We gathered the data on health care and social services use from central registers and medical records during 1 year before the intervention and 2 years after the intervention. We analyzed the total health care and social services use and costs per person-years and the difference in change in health-related quality of life as measured using the 15D measure. We calculated quality-adjusted life years and incremental cost-effectiveness ratios.
Results
There was no significant difference in baseline use of services or in the total use and costs of health care and social services during the 2-year follow-up between the two groups. In the intervention group, health-related quality of life declined significantly more slowly compared with the control group (–0.015), but there was no significant difference in quality-adjusted life years gained between the groups. The cost-effectiveness plane showed 60% of incremental cost-effectiveness ratios lying in the dominant quadrant, representing additional effects with lower costs.
Conclusions
This multiprofessional preventive home visit intervention appears to have positive effects on health-related quality of life without accruing additional costs.
The clinical trial registration number
ACTRN12616001411437.
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Affiliation(s)
- Heini A Liimatta
- Hyvinkää City Health Center, University of Helsinki, Uusimaa, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Uusimaa, Finland
| | - Pekka Lampela
- Hyvinkää City Health Center, University of Helsinki, Uusimaa, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Uusimaa, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Uusimaa, Finland
| | - Pirjo Laitinen-Parkkonen
- Keski-Uusimaa Joint Municipality Authority for Health Care and Social Services, Uusimaa, Finland
| | - Kaisu H Pitkala
- Department of General Practice and Primary Health Care, University of Helsinki, Uusimaa, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Uusimaa, Finland
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Buist Y, Rijken M, Lemmens L, Baan C, de Bruin S. Collaborating on Early Detection of Frailty; a Multifaceted Challenge. Int J Integr Care 2019; 19:6. [PMID: 31065238 PMCID: PMC6484371 DOI: 10.5334/ijic.4176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 03/20/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In several countries, initiatives to detect frailty among older citizens at an early stage are being implemented to enable proactive intervention and, consequently, to support independent living for as long as possible. Alignment and collaboration between the various actors are crucial. We aimed to provide insight in factors that impede or facilitate collaboration at a local level as perceived by the different actors and we explore their experiences. METHODS Semi-structured interviews were conducted with 37 representatives of three groups active in proactive elderly care in the Netherlands: (i) commissioners, (ii) service providers, and (iii) other stakeholders (e.g. public health advisors, academics). The Framework Method was used to analyse data. RESULTS Interviewees perceived many factors hampering or facilitating collaboration. Overall, the factors mentioned were quite similar for the different groups. Facilitators and barriers were related to culture and professionals (e.g. knowledge of early detection approaches, mutual trust), organizations (e.g. shared vision or patient information system) and context (e.g. financing). DISCUSSION AND CONCLUSION Collaborating on early detection appears to be a multifaceted challenge. However, as different stakeholders hold similar views, there seem to be several starting-points to improve collaboration. First steps shall include getting to know each other and developing a shared vision on early detection.
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Affiliation(s)
- Yvette Buist
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, NL
| | - Mieke Rijken
- Netherlands institute for health services research, Utrecht, NL
| | - Lidwien Lemmens
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, NL
| | - Caroline Baan
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, NL
| | - Simone de Bruin
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Bilthoven, NL
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Liimatta H, Lampela P, Laitinen-Parkkonen P, Pitkala KH. Effects of preventive home visits on health-related quality-of-life and mortality in home-dwelling older adults. Scand J Prim Health Care 2019; 37:90-97. [PMID: 30810457 PMCID: PMC6452824 DOI: 10.1080/02813432.2019.1569372] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults. DESIGN A randomised controlled trial. SUBJECTS Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group. SETTING Hyvinkää town municipality, Finland. MAIN OUTCOME MEASURES We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers. RESULTS At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was -0.015 (95% CI -0.029 to -0.0016; p = 0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up. CONCLUSION Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end. Key points We are exploring preventive home visits as means to support the health-related quality-of-life (HRQoL) of home-dwelling older adults Multiprofessional preventive home visits in this intervention study helped to maintain the HRQoL when measured using 15D The effects on HRQoL diminished when the intervention ended, so could further benefits be attained with a longer intervention?The clinical trial registration number: ACTRN12616001411437.
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Affiliation(s)
- Heini Liimatta
- Hyvinkää City Health Centre, Hyvinkää, Finland;
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland;
- CONTACT Heini Liimatta , Hyvinkää City Health Center, Sandelininkatu 1, 05800Hyvinkää, Finland
| | | | | | - Kaisu H. Pitkala
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland;
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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Zingmark M, Norström F, Lindholm L, Dahlin-Ivanoff S, Gustafsson S. Modelling long-term cost-effectiveness of health promotion for community-dwelling older people. Eur J Ageing 2019; 16:395-404. [PMID: 31798365 PMCID: PMC6857142 DOI: 10.1007/s10433-019-00505-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.
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Affiliation(s)
- Magnus Zingmark
- Health and Social Care Administration, Municipality of Östersund, 83182 Östersund, Sweden.,2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Fredrik Norström
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Lars Lindholm
- 2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187 Umeå, Sweden
| | - Synneve Dahlin-Ivanoff
- 3Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,4University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden
| | - Susanne Gustafsson
- 3Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,4University of Gothenburg Centre for Ageing and Health (AgeCap), Gothenburg, Sweden
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Franse CB, van Grieken A, Alhambra-Borrás T, Valía-Cotanda E, van Staveren R, Rentoumis T, Markaki A, Bilajac L, Marchesi VV, Rukavina T, Verma A, Williams G, Koppelaar E, Martijn R, Voorham AJ, Mattace Raso F, Garcés-Ferrer J, Raat H. The effectiveness of a coordinated preventive care approach for healthy ageing (UHCE) among older persons in five European cities: A pre-post controlled trial. Int J Nurs Stud 2018; 88:153-162. [DOI: 10.1016/j.ijnurstu.2018.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 12/24/2022]
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Abrams R, Wong G, Mahtani KR, Tierney S, Boylan AM, Roberts N, Park S. Understanding the impact of delegated home visiting services accessed via general practice by community-dwelling patients: a realist review protocol. BMJ Open 2018; 8:e024876. [PMID: 30429150 PMCID: PMC6252761 DOI: 10.1136/bmjopen-2018-024876] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In western countries, early visiting services (EVS) have been proposed as a recent intervention to reduce both general practitioner workload and hospital admissions among housebound individuals experiencing a healthcare need within the community. EVS involves the delegation of the patient home visits to other staff groups such as paramedics or nursing staff. However, the principles of organising this care are unknown and it remains unclear how different contexts, such as patient conditions and the processes of organising EVS influence care outcomes. A review has been designed to understand how EVS are enacted and, specifically, who benefits, why, how and when in order to provide further insight into the design and delivery of EVS. METHODS AND ANALYSIS The purpose of this review is to produce findings that provide explanations of how and why EVS contexts influence their associated outcomes. Evidence on EVS will be consolidated through realist review-a theory-driven approach to evidence synthesis. A realist approach is needed as EVS is a complex intervention. What EVS achieve is likely to vary for different individuals and contexts. We expect to synthesise a range of relevant data such as qualitative, quantitative and mixed-method research in the following stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesising and refining the programme theory. ETHICS AND DISSEMINATION A formal ethics review is not required as this study is secondary research. Findings will be disseminated in a peer-reviewed journal, at national and international conferences and to relevant professional associations. PROSPERO REGISTRATION NUMBER CRD42018096518.
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Affiliation(s)
- Ruth Abrams
- Department of Primary Care and Population Health, Institute of Epidemiology and Public Health UCL Medical School, London, UK
| | - Geoffrey Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal Ram Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Sophie Park
- Department of Primary Care and Population Health, Institute of Epidemiology and Public Health UCL Medical School, London, UK
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Fjell A, Cronfalk BS, Carstens N, Rongve A, Kvinge LMR, Seiger Å, Skaug K, Boström AM. Risk assessment during preventive home visits among older people. J Multidiscip Healthc 2018; 11:609-620. [PMID: 30425507 PMCID: PMC6205137 DOI: 10.2147/jmdh.s176646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Preventive home visits (PHV) may contribute to identify risks and needs in older people, and thereby delay the onset of functional decline and illness, otherwise often followed by home care or admission to hospital or nursing homes. There is a need to increase knowledge about which factors are associated with different risk areas among older people, so that the PHV questionnaire focuses on relevant tests and questions to make the PHV more specific and have a clear focus and purpose. Objective The objective of this study was to examine associations between five kinds of risks: risk of falls, malnutrition, polypharmacy, cognitive impairment, and risk of developing illness and factors related to lifestyle, health, and medical diagnoses among older people living at home. Methods A cross-sectional study design was applied. PHV were conducted by nurses among 77-year-old people in an urban municipality and among ≥75-year-old people in a rural municipality. A questionnaire including tests and a risk assessment score for developing illness was used. Descriptive and inferential statistics including regression models were analyzed. Results The total sample included 166 persons. Poor perceived health was associated with increased risk of developing illness and risk of fall, malnutrition, and polypharmacy. Lifestyle and health factors such as lack of social support, sleep problems, and feeling depressed were associated with risk of developing illness. Risk of falls, malnutrition, polypharmacy, and cognitive impairment were also associated with increased risk of developing illness. None of the independent factors related to lifestyle, health, or medical diagnosis were associated with risk of cognitive impairment. Conclusion Poor perceived health was associated with health-related risks in older persons living at home. Preventive health programs need to focus on social and lifestyle factors and self-reported health assessment to identify older people at risk of developing illnesses.
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Affiliation(s)
- Astrid Fjell
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden, .,Department of Nursing, Western Norway University of Applied Sciences, Haugesund, Norway,
| | - Berit Seiger Cronfalk
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden, .,Department of Nursing Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Nina Carstens
- Hospital Pharmacies Enterprise, Western Norway, Bergen, Norway
| | - Arvid Rongve
- Department of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Åke Seiger
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Knut Skaug
- Department of Medicine, Helse Fonna, Haugesund Hospital, Haugesund, Norway
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden, .,Department of Nursing, Western Norway University of Applied Sciences, Haugesund, Norway, .,Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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Van der Elst M, Schoenmakers B, Duppen D, Lambotte D, Fret B, Vaes B, De Lepeleire J. Interventions for frail community-dwelling older adults have no significant effect on adverse outcomes: a systematic review and meta-analysis. BMC Geriatr 2018; 18:249. [PMID: 30342479 PMCID: PMC6195949 DOI: 10.1186/s12877-018-0936-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to some studies, interventions can prevent or delay frailty, but their effect in preventing adverse outcomes in frail community-dwelling older people is unclear. The aim is to investigate the effect of an intervention on adverse outcomes in frail older adults. METHODS A systematic review and meta-analysis of Medline, Embase, the Cochrane Library, and Social Sciences Citation Index. Randomized controlled studies that aimed to treat frail community-dwelling older adults, were included. The outcomes were mortality, hospitalization, formal health costs, accidental falls, and institutionalization. Several sub-analyses were performed (duration of intervention, average age, dimension, recruitment). RESULTS Twenty-five articles (16 original studies) were included. Six types of interventions were found. The pooled odds ratios (OR) for mortality when allocated in the experimental group were 0.99 [95% CI: 0.79, 1.25] for case management and 0.78 [95% CI: 0.41, 1.45] for provision information intervention. For institutionalization, the pooled OR with case management was 0.92 [95% CI: 0.63, 1.32], and the pooled OR for information provision intervention was 1.53 [95% CI: 0.64, 3.65]. The pooled OR for hospitalization when allocated in the experimental group was 1.13 [95% CI: 0.95, 1.35] for case management. Further sub-analyses did not yield any significant findings. CONCLUSION This systematic review and meta-analysis does not provide sufficient scientific evidence that interventions by frail older adults can be protective against the included adverse outcomes. A sub-analysis for some variables yielded no significant effects, although some findings suggested a decrease in adverse outcomes. TRIAL REGISTRATION Prospero registration CRD42016035429 .
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Affiliation(s)
- Michael Van der Elst
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
| | - Daan Duppen
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - Deborah Lambotte
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - Bram Fret
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, B-1200 Brussels, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
| | - D-SCOPE Consortium
- Department of Public Health and Primary Care, University of Leuven, Kapucijnenvoer 33 bus 7001, B-3000 Leuven, Belgium
- Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium
- Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-champs 30, B-1200 Brussels, Belgium
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Blom JW, Van den Hout WB, Den Elzen WPJ, Drewes YM, Bleijenberg N, Fabbricotti IN, Jansen APD, Kempen GIJM, Koopmans R, Looman WM, Melis RJF, Metzelthin SF, Moll van Charante EP, Muntinga ME, Numans ME, Ruikes FGH, Spoorenberg SLW, Stijnen T, Suijker JJ, De Wit NJ, Wynia K, Wind AW, Gussekloo J. Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis. Age Ageing 2018. [PMCID: PMC6108387 DOI: 10.1093/ageing/afy091] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting primary care sector. Interventions combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes quality of life (visual analogue scale 0–10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was −0.01 (95% confidence interval −0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.
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Affiliation(s)
- J W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - W B Van den Hout
- Department of Biomedical Data Sciences—Medical Decision Making, Leiden University Medical Center, RC Leiden, The Netherlands
| | - W P J Den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, RC Leiden, The Netherlands
| | - Y M Drewes
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - N Bleijenberg
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - I N Fabbricotti
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, CA Rotterdam, The Netherlands
| | - A P D Jansen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, MB Amsterdam, The Netherlands
| | - G I J M Kempen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - R Koopmans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - W M Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, CA Rotterdam, The Netherlands
| | - R J F Melis
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - S F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - E P Moll van Charante
- Department of General Practice, Academic Medical Center, DD Amsterdam, The Netherlands
| | - M E Muntinga
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, MB Amsterdam, The Netherlands
| | - M E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - F G H Ruikes
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | - S L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Internal postal code FA10, AD Groningen, The Netherlands
| | - T Stijnen
- Department of Medical Statistics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - J J Suijker
- Department of General Practice, Academic Medical Center, DD Amsterdam, The Netherlands
| | - N J De Wit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA Utrecht, The Netherlands
| | - K Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Internal postal code FA10, AD Groningen, The Netherlands
| | - A W Wind
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
| | - J Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, RC Leiden, The Netherlands
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, RC Leiden, The Netherlands
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van Blijswijk SCE, Blom JW, de Craen AJM, den Elzen WPJ, Gussekloo J. Prediction of functional decline in community-dwelling older persons in general practice: a cohort study. BMC Geriatr 2018; 18:140. [PMID: 29898672 PMCID: PMC6001140 DOI: 10.1186/s12877-018-0826-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A first step to offer community-dwelling older persons proactive care is to identify those at risk of functional decline within a year. This study investigates the predictive value of registered information, questionnaire and GP-opinion on functional decline. METHODS In this cohort study, embedded within the ISCOPE-trial, participants (≥75 years) completed the ISCOPE-screening questionnaire on four health domains. GPs gave their opinion on vulnerability of participants. Functional status was measured at baseline and 12 months (Groningen Activities Restriction Scale [GARS]). The outcome was functional decline (death, nursing home admission, 10% with greatest functional decline). The predictive value of pre-selected variables (age, sex, polypharmacy, multimorbidity, living situation; GPs' opinion on vulnerability, number of domains with problems [ISCOPE-score]) was compared with the area under the curves (AUC) for logistic regression models. RESULTS 2018 of the 2211 participants (median age 82.1 years [IQR 78.8-86.5], 68.0% female, median GARS 31 [IQR 24-41]) were visited at 12 months (median GARS 34 [IQR 26-44]). 394 participants (17.8%) had functional decline (148 died, 45 nursing home admissions, 201 with greatest functional decline). The AUC for age and sex was 0.602, increasing to 0.620 (p = 0.029) with polypharmacy, multimorbidity and living situation. The GPs' opinion added more (AUC 0.672, p < 0.001) than the ISCOPE-score (AUC 0.649, p = 0.007). AUC with all variables was 0.686 (p = 0.016), and 0.643 for GPs' opinion alone. CONCLUSIONS The GPs' opinion and ISCOPE-score improve this prediction model for functional decline based on readily available variables. GPs could identify older patients for further assessment with their clinical judgement. TRIAL REGISTRATION Netherlands trial register, NTR1946 . Registered 10 August 2009.
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Affiliation(s)
- Sophie C E van Blijswijk
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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40
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Kim CO, Jang SN. Home-Based Primary Care for Homebound Older Adults: Literature Review. Ann Geriatr Med Res 2018; 22:62-72. [PMID: 32743249 PMCID: PMC7387609 DOI: 10.4235/agmr.2018.22.2.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/18/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022] Open
Abstract
Home-based primary care (HBPC) refers to the type of home care services which provide interdisciplinary primary care services with a comprehensive and continuous manner. Currently, it is getting much attention due to possess potential of converting primary care services from outpatient clinic to home, especially for those who are medically isolated including homebound older adults. This study examined a number of HBPCs introduced in the literature since 1990s, and summarizes the key factors with the analytic framework of 5Ps: purpose, patients, people, process, patterns. The results of this study emphasize that contents of primary care for older population should be different from those of the general population. This paper may be interpreted as the practice guideline of the following policy questions: “How can we design the HBPC if it is introduced in the nearest future?” In the future, it is necessary to have a heated debate concerning what is the most desirable primary care system for older adults.
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Affiliation(s)
- Chang-O Kim
- Institute of Social Welfare, Sungkonghoe University, Seoul, Korea.,Clinical Research Center, Yangji Hospital, Seoul, Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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41
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Lovink MH, van Vught AJAH, Persoon A, Schoonhoven L, Koopmans RTCM, Laurant MGH. Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study. BMC FAMILY PRACTICE 2018; 19:51. [PMID: 29720099 PMCID: PMC5932890 DOI: 10.1186/s12875-018-0746-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
Abstract
Background More and more older adults desire to and are enabled to grow old in their own home, regardless of their physical and mental capabilities. This change, together with the growing number of older adults, increases the demand for general practitioners (GPs). However, care for older people lacks prestige among medical students and few medical students are interested in a career in care for older people. Innovative solutions are needed to reduce the demand for GPs, to guarantee quality of healthcare and to contain costs. A solution might be found in skill mix change by introducing nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs). The aim of this study was to describe how skill mix change is organised in daily practice, what influences it and what the effects are of introducing NPs, PAs or RNs into primary healthcare for older people. Methods In total, 34 care providers working in primary healthcare in the Netherlands were interviewed: GPs (n = 9), NPs (n = 10), PAs (n = 5) and RNs (n = 10). Five focus groups and 14 individual interviews were conducted. Analysis consisted of open coding, creating categories and abstraction. Results In most cases, healthcare for older people was only a small part of the tasks of NPs, PAs and RNs; they did not solely focus on older people. The tasks they performed and their responsibilities in healthcare for older people differed between, as well as within, professions. Although the interviewees debated the usefulness of proactive structural screening on frailty in the older population, when implemented, it was also unclear who should perform the geriatric assessment. Interviewees considered NPs, PAs and RNs an added value, and it was stated that the role of the GP changed with the introduction of NPs, PAs or RNs. Conclusions The roles and responsibilities of NPs, PAs and RNs for the care of older people living at home are still not established. Nonetheless, these examples show the potential of these professionals. The establishment of a clear vision on primary healthcare for older people, including the organisation of proactive healthcare, is necessary to optimise the impact of skill mix change. Electronic supplementary material The online version of this article (10.1186/s12875-018-0746-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marleen H Lovink
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. box 9101, 114 6500, HB, Nijmegen, The Netherlands.
| | - Anneke J A H van Vught
- Faculty of Health and Social Studies, HAN University of Applied Sciences, P.O. box 6960, 6503, GL, Nijmegen, The Netherlands
| | - Anke Persoon
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical center, P.O. box 9101, 119 6500, HB, Nijmegen, The Netherlands
| | - Lisette Schoonhoven
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. box 9101, 114 6500, HB, Nijmegen, The Netherlands.,Faculty of Health Sciences, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Raymond T C M Koopmans
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical center, P.O. box 9101, 119 6500, HB, Nijmegen, The Netherlands.,Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Miranda G H Laurant
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. box 9101, 114 6500, HB, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, P.O. box 6960, 6503, GL, Nijmegen, The Netherlands
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42
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Theocharis G, Barbas SG, Spiropoulos T, Stamouli PE, Perdikis DN, Falagas ME. Patient house calls in Attica and Thessaloniki, Greece (2005-2015): a model for out-of-hospital multispecialty emergency medicine. BMC Health Serv Res 2018; 18:304. [PMID: 29703193 PMCID: PMC5923023 DOI: 10.1186/s12913-018-3111-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SOS-doctors are a network of physicians who perform house-call visits in the areas of Attica and Thessaloniki, Greece. METHODS Patients requesting medical services by the SOS doctors during the period 1/1/2005 - 31/12/2015 were eligible for inclusion in this retrospective analysis. RESULTS During this period 335, 212 home visits were performed. Females used this service more frequently compared to males (60.5% versus 39.5%). Among the age-groups, patients aged over 75 years made 56.6% of all house calls. Fewer phone requests were recorded during autumn than in winter (21.1% versus 29.1%). Infections were the most common cause of house-visits (29%), followed by cardiovascular diseases (10.3%), musculoskeletal (9.1%), gastrointestinal (6.3%) and neurological disorders (3.7%). An increasing demand for radiology at home was observed, starting at 352 calls in 2009 and reaching 2230 in 2015. Finally, 9.2% of patients were advised to be admitted into a hospital. CONCLUSION A shift towards older age, but not the oldest old (> 90 years), and acute conditions was observed during the study period. The study confirms that home visits retain a significant role in the modern health care systems.
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Affiliation(s)
- George Theocharis
- SOS doctors, Athens, Greece.,Department of Medicine, "Euroclinic" General Clinic, Athens, Greece
| | | | | | - Petroula E Stamouli
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Dimitrios N Perdikis
- Department of Applied Mathematical and Physical Sciences, National Technical University of Athens, Athens, Greece
| | - Matthew E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23, Marousi, Greece. .,Department of Medicine, Henry Dunant Hospital Center, Athens, Greece. .,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
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Tøien M, Bjørk IT, Fagerström L. An exploration of factors associated with older persons' perceptions of the benefits of and satisfaction with a preventive home visit service. Scand J Caring Sci 2017; 32:1093-1107. [PMID: 29250819 DOI: 10.1111/scs.12555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 11/29/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preventive home visits (PHVs) are healthcare services aimed at promoting the health of home-dwelling older people and to support their abilities to live independently. To enhance effectiveness, studies that explore older persons' experiences of PHVs are needed. OBJECTIVE To assess older persons' perceived benefits and opinions of a PHV service and explore associations between perceived benefits from PHV and relevant sociodemographic/health-related factors. THEORY The study was based on a comprehensive understanding of health, as including objective health/disease, subjective health/well-being and coping ability. METHODS A cross-sectional survey was administered during spring 2013 in a Norwegian municipality where nurses had offered annual PHVs to residents aged 75 years and older since 1999. We invited a stratified random sample of 393 PHV users to participate; of these, 161 volunteered. The main outcome variables in the questionnaire were perceived benefits from PHV. Logistic regression models were used to analyse the associations between each benefit and sociodemographic/health-related background variables. RESULTS Approximately 39% of the respondents reported that PHVs added to their feelings of safety; 66% reported support for ability to live at home; 72% reported support for having a good life, 83% were satisfied with the service, and 90% stated that PHVs are important for older people. Each benefit was associated with different sociodemographic/health-related factors. Support for feelings of safety increased with age. More support for living at home was associated with poor physical health and not living alone. Those without children perceived more support for a good life. Satisfaction with PHV increased with increasing scores on the Life Orientation Scale. Persons with poor mental health and those not living alone more often perceived PHV as important. CONCLUSIONS Annual, comprehensive PHVs to a general older population may support older persons' health and independence. Low response rate restricts the possibility to generalise the results.
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Affiliation(s)
- Mette Tøien
- Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway.,Department of Nursing Science, University of Oslo, Oslo, Norway
| | | | - Lisbeth Fagerström
- Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway.,Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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44
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King AII, Boyd ML, Dagley L, Raphael DL. Implementation of a gerontology nurse specialist role in primary health care: Health professional and older adult perspectives. J Clin Nurs 2017; 27:807-818. [PMID: 29052288 DOI: 10.1111/jocn.14110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore an innovative primary healthcare gerontology nurse specialist role from the perspectives of older people and health professionals. BACKGROUND Primary care is struggling to meet the needs and demands of complex older people. New models which incorporate holistic assessment and care coordination are necessary. DESIGN A qualitative descriptive general inductive design was used. METHODS Older people at risk of health and functional decline were identified and received a comprehensive gerontology assessment and care coordination. Older adults (75 years+) enrolled within one of three primary healthcare practices in Auckland, New Zealand were eligible. Healthcare professionals directly involved with the primary healthcare gerontology nurse specialist model were invited for study participation. Face-to-face interviews were held with five older people and six health professionals were interviewed by telephone. A semistructured interview guide was used for all interviews. A general inductive approach was undertaken for analysis to systematically identify codes and themes. RESULTS Data analysis revealed two central themes from the older people perspective: "holistic expertise" and "communication." Two main themes were identified from the health professional perspective: "competency" and "service delivery." Results showed the gerontology nurse specialist role was highly regarded by both older people and the health professionals. The in-home comprehensive geriatric assessment was identified as greatly beneficial. CONCLUSIONS The competence and care coordination of the gerontology nurse specialist reduced fragmentation and were deemed immensely valuable. Care coordination should be recognised as a key component to meeting the complex needs of at-risk older people in the community. RELEVANCE TO CLINICAL PRACTICE The expert knowledge of the gerontology nurse specialist and in-home comprehensive geriatric assessment were crucial aspects of the new model. Equally important was the assimilation of primary and secondary care infrastructure to upskill and deliver mentorship to the gerontology nurse specialist.
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Affiliation(s)
- Anna I I King
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Michal L Boyd
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | | | - Deborah L Raphael
- School of Nursing, The University of Auckland, Auckland, New Zealand
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45
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Liimatta H, Lampela P, Laitinen-Parkkonen P, Pitkala K. Preventive home visits to promote the health-related quality of life of home-dwelling older people: Baseline findings and feasibility of a randomized, controlled trial. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schonheit C, Rousselle Q, Cara I, Curtis V, Mézière A. [The occupational therapist and the assessment of the elderly person's home]. SOINS. GERONTOLOGIE 2017; 22:29-33. [PMID: 29132661 DOI: 10.1016/j.sger.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The falls of elderly people in their home are frequently related to the environment. Plans and photographs of the home provided by the patient's relatives are useful and constitute relevant assessment tools. The home visit is even more effective as it helps to identify areas which pose a high risk of falling which cannot be picked up by the other tools.
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Affiliation(s)
- Claire Schonheit
- Soins de suite et réadaptation orthogériatrique, GHU La Pitié-Salpêtrière-Charles Foix, AP-HP, 7 avenue de la République, 94200 Ivry-sur-Seine, France
| | - Quentin Rousselle
- Université Paris-Descartes, Master Sciences du sport et de la motricité, spécialité vieillissement, handicap : mouvement et adaptation, 1 rue Lacretelle, 75015 Paris, France
| | - Isabelle Cara
- Soins de suite et réadaptation orthogériatrique, GHU La Pitié-Salpêtrière-Charles Foix, AP-HP, 7 avenue de la République, 94200 Ivry-sur-Seine, France
| | - Valentine Curtis
- Soins de suite et réadaptation orthogériatrique, GHU La Pitié-Salpêtrière-Charles Foix, AP-HP, 7 avenue de la République, 94200 Ivry-sur-Seine, France
| | - Anthony Mézière
- Soins de suite et réadaptation orthogériatrique, GHU La Pitié-Salpêtrière-Charles Foix, AP-HP, 7 avenue de la République, 94200 Ivry-sur-Seine, France.
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Siu HYH, Steward N, Peter J, Cooke L, Arnold DM, Price D. A novel primary-specialist care collaborative demonstration project to improve the access and health care of medically complex patients. Chronic Illn 2017; 13:151-170. [PMID: 28783974 DOI: 10.1177/1742395316674541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Medically complex patients experience fragmented health care compounded by long wait times. The MedREACH program was developed to improve access and overall system experience for medically complex patients. Program description MedREACH is a novel primary-tertiary care collaborative demonstration program that features community nursing outreach, community specialist outreach, and a multi-specialty consultation clinic. Methods All 179 patients, referring primary care clinicians, and specialists involved were eligible to participate. Patient and clinician feedback were elicited by feedback surveys. Process measures were evaluated by participant retrospective chart reviews. Community nursing outreach patients completed the Goal Attainment Scale. Results Forty-eight patients and 22 clinicians consented to the feedback survey. About 75% of patients were seen within 2 weeks of referral. Patients spent an average of 3, 1.63, and 1.2 visits with the nursing outreach, multi-specialty clinic, and specialist outreach, respectively. Patients indicated a better medical experience, health enablement, and goals attainment. Family physicians felt more supported in the community management of medically complex patients and, overall, physicians felt MedREACH could improve collaborative care for medically complex patients. Qualitative analysis of clinician responses identified the need for increased mental health services. Discussion MedREACH demonstrates a patient-centered link between primary and tertiary care that could improve health care access and overall experience.
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Affiliation(s)
- Henry Yu-Hin Siu
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Jessica Peter
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Laurel Cooke
- 3 Nursing and Complex Care Teams, Hamilton Family Health Team, Hamilton, ON, Canada
| | - Donald M Arnold
- 4 Department of Medicine (Division of Hematology and Thromboembolism), McMaster University, Hamilton, ON, Canada
| | - David Price
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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48
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Colquhoun HL, Sattler D, Chan C, Walji T, Palumbo R, Chalmers I, Jokhio I, Ivers NM. Applying User-Centered Design to Develop an Audit and Feedback Intervention for the Home Care Sector. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017. [DOI: 10.1177/1084822317700883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 ( n = 33) and Phase 2 ( n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management.
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Affiliation(s)
| | - Deborah Sattler
- Erie St. Clair Local Health Integration Network, Toronto, Ontario, Canada
| | - Christine Chan
- Erie St. Clair Local Health Integration Network, Toronto, Ontario, Canada
| | - Taheera Walji
- Region of Waterloo Public Health and Emergency Services, Ontario, Canada
| | - Rachel Palumbo
- Hospice of Windsor and Essex County Inc, Ontario, Canada
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Lette M, Stoop A, Lemmens LC, Buist Y, Baan CA, de Bruin SR. Improving early detection initiatives: a qualitative study exploring perspectives of older people and professionals. BMC Geriatr 2017. [PMID: 28645251 PMCID: PMC5482941 DOI: 10.1186/s12877-017-0521-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background A wide range of initiatives on early detection and intervention have been developed to proactively identify problems related to health and wellbeing in (frail) older people, with the aim of supporting them to live independently for as long as possible. Nevertheless, it remains unclear what the best way is to design such initiatives and how older people’s needs and preferences can be best addressed. This study aimed to address this gap in the literature by exploring: 1) older people’s perspectives on health and living environment in relation to living independently at home; 2) older people’s needs and preferences in relation to initiating and receiving care and support; and 3) professionals’ views on what would be necessary to enable the alignment of early detection initiatives with older people’s own needs and preferences. Methods In this qualitative study, we conducted semi-structured interviews with 36 older people and 19 professionals in proactive elderly care. Data were analysed using the framework analysis method. Results From the interviews with older people important themes in relation to health and living environment emerged, such as maintaining independence, appropriate housing, social relationships, a supporting network and a sense of purpose and autonomy. Older people preferred to remain self-sufficient, and they would rather not ask for help for psychological or social problems. However, the interviews also highlighted that they were not always able or willing to anticipate future needs, which can hinder early detection or early intervention. At the same time, professionals indicated that older people tend to over-estimate their self-reliance and therefore advocated for early detection and intervention, including social and psychological issues. Conclusion Older people have a broad range of needs in different domains of life. Discrepancies exist between older people and professionals with regard to their views on timing and scope of early detection initiatives. This study aimed to reveal starting-points for better alignment between initiatives and older people’s needs and preferences. Such starting points may support policy makers and care professionals involved in early detection initiatives to make more informed decisions. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0521-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manon Lette
- Amsterdam Public Health research institute, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands. .,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Annerieke Stoop
- Amsterdam Public Health research institute, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands.,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Scientific Center for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
| | - Lidwien C Lemmens
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Yvette Buist
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Caroline A Baan
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Scientific Center for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
| | - Simone R de Bruin
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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50
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Araujo de Carvalho I, Epping-Jordan J, Pot AM, Kelley E, Toro N, Thiyagarajan JA, Beard JR. Organizing integrated health-care services to meet older people's needs. Bull World Health Organ 2017; 95:756-763. [PMID: 29147056 PMCID: PMC5677611 DOI: 10.2471/blt.16.187617] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/16/2017] [Accepted: 04/20/2017] [Indexed: 11/27/2022] Open
Abstract
In most countries, a fundamental shift in the focus of clinical care for older people is needed. Instead of trying to manage numerous diseases and symptoms in a disjointed fashion, the emphasis should be on interventions that optimize older people’s physical and mental capacities over their life course and that enable them to do the things they value. This, in turn, requires a change in the way services are organized: there should be more integration within the health system and between health and social services. Existing organizational structures do not have to merge; rather, a wide array of service providers must work together in a more coordinated fashion. The evidence suggests that integrated health and social care for older people contributes to better health outcomes at a cost equivalent to usual care, thereby giving a better return on investment than more familiar ways of working. Moreover, older people can participate in, and contribute to, society for longer. Integration at the level of clinical care is especially important: older people should undergo comprehensive assessments with the goal of optimizing functional ability and care plans should be shared among all providers. At the health system level, integrated care requires: (i) supportive policy, plans and regulatory frameworks; (ii) workforce development; (iii) investment in information and communication technologies; and (iv) the use of pooled budgets, bundled payments and contractual incentives. However, action can be taken at all levels of health care from front-line providers through to senior leaders – everyone has a role to play.
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Affiliation(s)
- Islene Araujo de Carvalho
- Department of Ageing and Life Course, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | | | - Anne Margriet Pot
- Department of Evidence, Research, Action on Mental and Brain Disorders, World Health Organization, Geneva, Switzerland
| | - Edward Kelley
- Service Delivery and Safety Department, World Health Organization, Geneva, Switzerland
| | - Nuria Toro
- Department of Services Organization and Clinical Interventions, World Health Organization, Geneva, Switzerland
| | - Jotheeswaran A Thiyagarajan
- Department of Ageing and Life Course, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
| | - John R Beard
- Department of Ageing and Life Course, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland
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