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Can They Keep Going on Their Own? A Four-Year Randomized Trial of Functional Assessments of Community Residents*

Published online by Cambridge University Press:  31 March 2010

Roger Thomas ,
Graham Worrall ,
Frank Elgar  and
John Knight
Roger Thomas*
Affiliation:
University of Calgary
Graham Worrall
Affiliation:
Memorial University of Newfoundland
Frank Elgar
Affiliation:
Carleton University, Ottawa
John Knight
Affiliation:
Newfoundland & Labrador Centre for Health Information
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Dr Roger Thomas, Department of Family Medicine, University of Calgary. ([email protected])
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Abstract

Objectives: Are people 75 or over enabled to stay at home longer through annual assessments and referrals to health/social services than through assessments only or without assessments?

Design: randomized controlled trial

Participants: 520 people 75 or over living in their own homes

Intervention: Four annual RAI-HC computerized functional assessments. Intervention group 1: elders and primary caregivers received the results and were invited to take appropriate actions. Intervention group 2: elders and primary caregivers were offered referrals to health/social services.

Measurements/Outcomes: death, institutionalization, home care services, RAI-HC scores, self-rated health, perceived self-efficacy, caregiver burden

Results: By the end of the study, annual functional assessment and offers of referrals to health/social services led to a greater use of home care (6.3%) than did assessment alone (1.8%), but there were no significant differences in death rates, institutionalization, perceived self-efficacy, self-rated health status, or caregiver burden scores between groups.

Conclusion: We discovered that this was a group of healthy seniors. Multi-dimensional functional assessment is time- and labour-intensive and should be targeted at the minority of least self-reliant seniors.

Résumé

Objectif: Des personnes âgées de 75 ans et plus peuvent-elles demeurer plus longtemps à domicile si elles sont l'objet d'évaluations annuelles ou sont dirigées vers des services sociaux ou de santé plutôt que si elles sont l'objet d'évaluations seulement ou d'aucune évaluation?

Concept: Essais cliniques aléatoires

Participants: 520 personnes de 75 ans et plus demeurant dans leur propre maison

Interventions: Un IEP (Instrument d'évaluation du pensionnaire) - soins à domicile (RAI-HC/Resident Assessment Instrument for Home Care) a informatisé des évaluations fonctionnelles. Groupe d'intervention 1: les aînés et les principaux dispensateurs de soins ont reçu les résultats et étaient invités à prendre les mesures appropriées. Groupe d'intervention 2: les aînés et les principaux dispensateurs de soins étaient dirigés vers des services sociaux ou de santé.

Mesures/effets: décès, institutionnalisation, soins à domicile, résultats de l'IÉP - soins à domicile, santé autoévaluée par l'aîné, et charge du dispensateur de soins.

Résultats: À la fin de l'étude, l'évaluation fonctionnelle annuelle et les offres de réacheminement vers des services sociaux ou de santé ont permis d'utiliser davantage les services à domicile (6,3%) que les évaluations annuelles seules (1,8%), mais il n'y avait aucune différence importante entre les groupes en taux de mortalité, degré d'instutionalisation, l'autoefficacité, perçue, l'autoévaluation de santé, ou le fardeau du dispensateur de soins.

Conclusions: Nous avons constaté que ce groupe d'aînés était en bonne santé. Le système multidimensionnel d'évaluation fonctionnelle exige beaucoup de temps et de main-d'oeuvre et doit être réservé au petit nombre d'aînés les moins autonomes.

Keywords

agingrandomized trialelderly over 75functional assessmentcare needsremain in own homevieillissementessais aléatoirespersonnes âgées de plus de 75 ansévaluation des capacités fonctionnellesbesoins en soins de santévie autonome à domicile
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 26 , Issue 4 , Winter/Hiver 2007 , pp. 379 - 389
Copyright
Copyright © Canadian Association on Gerontology 2007

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Footnotes

*

Dr. John Hirdes and Dr. Jeff Poss of the University of Waterloo were consultants in the use of the RAI-HC and in training the research nurses. Glenda Sweetland, Phyllis Reid, and Verna Clouston were the research nurses who cheerfully did the field work for this study. For part of the study, Ms. Barbara Young was the research study coordinator. Ms. Theresa Kerrivan and Mr. Joseph Griffiths entered and organized most of the study data. Trial registration: Canadian Institutes of Health Research # 10576.

References

1Moore, EG, Rosenberg, MW, & McGuiness, D Growing old in Canada: demographic and geographic perspectives. (Report No. 96–321-MPE). Ottawa, ON: Statistics Canada; (1997).Google Scholar
2Statistics Canada National Public Health Survey 1994–95. Ottawa, ON: Minister of Industry; (1995).Google Scholar
3Denton, FT, & Spencer, BG (1995). Demographic change and the cost of the publicly funded health care system. Can J Aging, 14, 174–194.CrossRefGoogle Scholar
4Wasson, JH, Stukel, TA, Weiss, JE, Hays, RD, Jette, AM, & Nelson, EC (1999). A randomized trial of the use of patient self-assessment data to improve community practices. Eff Clin Pract, 2(1), 1–10.Google ScholarPubMed
5Toseland, RW, O'Donnell, JC, Engelhardt, JB, Richie, J, Jue, D, & Banks, SM (1997). Outpatient geriatric evaluation and management: is there an investment effect? Gerontologist, 37(3), 324–332.CrossRefGoogle ScholarPubMed
6Tinetti, ME, Baker, DI, McAvay, G, Claus, EB, Garrett, P, Gottschalk, M, et al. (1994). A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med, 331(13), 821–827.CrossRefGoogle ScholarPubMed
7Tulloch, AJ, & Moore, V (1979). A randomized controlled trial of geriatric screening and surveillance in general practice. J R Coll Gen Pract, 29, 733–740.Google ScholarPubMed
8Van Rossum, E, Frederiks, CM, Philipsen, H, Portengen, K, Wiskerke, J, & Knipschild, P (1993). Effects of preventive home visits to elderly people. BMJ, 307, 27–32.CrossRefGoogle ScholarPubMed
9Hall, N, De Beck, P, Johnson, D, Mackinnon, K, Gutman, G, & Glick, N (1992). Randomized trial of a health promotion program for frail elders. Can J Aging, 11, 72–91.CrossRefGoogle Scholar
10Gunner-Svensson, , Ipsen, J, Olsen, J, & Waldstrøm, BD (1984). Prevention of relocation of the aged in nursing homes. Scan J Prim Health Care, 2, 49–56.CrossRefGoogle ScholarPubMed
11Stück, AE, Aronow, HU, Steiner, A, Alessi, CA, Bula, CJ, Gold, MN, et al. (1995). A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med, 333(18), 1184–1189.CrossRefGoogle ScholarPubMed
12Hendriksen, C, Lund, E, & Stromgard, E (1984). Consequences of assessment and intervention among elderly people: a three year randomised controlled trial. Br Med J (Clin Res Ed), 289, 1522–1524.CrossRefGoogle ScholarPubMed
13Pathy, MS, Bayer, A, Harding, K, & Dibble, A (1992). Randomised trial of case finding and surveillance of elderly people at home. Lancet, 340, 890–893.CrossRefGoogle ScholarPubMed
14Vetter, NJ, Jones, DA, & Victor, CR (1984). Effect of health visitors working with elderly patients in general practice: a randomised controlled trial. Br Med J (Clin Res Ed), 288, 369–372.CrossRefGoogle ScholarPubMed
15Silverman, M, Musa, D, Martin, DC, Lave, JR, Adams, J, & Ricci, EM (1995). Evaluation of outpatient geriatric assessment: a randomized multi-site trial. J Am Geriatr Soc, 43(7), 733–740.CrossRefGoogle ScholarPubMed
16Epstein, AM, Hall, JA, Fretwell, M, Feldstein, M, DeCiantis, ML, Tognetti, J, et al. (1990). Consultative geriatric assessment for ambulatory patients: a randomized trial in a health maintenance organization. JAMA, 263(4), 538–544.CrossRefGoogle Scholar
17Williams, AM (1996). The development of Ontario's Home Care Program: a critical geographical analysis. Soc Sci Med, 42(6), 937–948.CrossRefGoogle Scholar
18Hay, WI, van Ineveld, C, Browne, G, Roberts, J, Bell, B, Mills, M, et al. (1998). Prospective care of elderly patients in family practice. Is screening effective? Can Fam Physician, 44, 2677–2687.Google Scholar
19Vetter, NJ, Lewis, PA, & Ford, D (1992). Can health visitors prevent fractures in elderly people? BMJ, 304, 888–890.CrossRefGoogle ScholarPubMed
20Sorensen, KH, & Sivertsen, J (1988). Follow-up three years after intervention to relieve unmet medical and social needs of old people. Compr Gerontol [B], 2(2), 85–91.Google ScholarPubMed
21Clarke, M, Clarke, SJ, & Jagger, C (1992). Social intervention and the elderly: a randomized controlled trial. Am J Epidemiol, 136(12), 1517–1523.CrossRefGoogle ScholarPubMed
22Moher, D, Schulz, KF, & Altman, D (2001). for the CONSORT Group The CONSORT Statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA, 285, 1987–1991.CrossRefGoogle Scholar
23Folstein, MF, Folstein, ME, & McHugh, PR (1975). Mini Mental State: a practical method for grading cognitive state for the clinician. J Psychiatr Res, 12(3), 189–198.CrossRefGoogle Scholar
24Jerusalem, M, Schwarzer, R Self-efficacy as a resource factor in stress appraisal processes. In Schwarzer, R editor. Self-efficacy: thought control of action. Washington, DC: Hemisphere; 1992 (pp. 195–213).Google Scholar
25Zarit, SH, Reever, KE, & Bach-Peterson, J (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649–655.CrossRefGoogle ScholarPubMed
26Paddock, K, & Hirdes, JP (2003). Acute health care service use among elderly home care clients. Home Health Care Serv Q, 22(1), 75–85.CrossRefGoogle ScholarPubMed
27Morris, JN, Fries, BE, Steel, K, Ikegami, N, Bernabei, R, Carpenter, GI, et al. (1997). Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc, 45(8), 1017–1024.CrossRefGoogle ScholarPubMed
28Morris, JN, Bernabei, R, Ikegami, N, Gilgen, R, Fries, B, Steel, K, et al. (1996). RAI-Home Care (RAI-HC) assessment manual. Washington, DC: InterRAI Corporation.Google Scholar
29Landi, F, Tua, E, Onder, G, Carrara, B, Sgadari, A, Rinaldi, C, et al. (2000). SILVERNET-HC Study Group of Bergamo. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care, 38(12), 1184–1190.CrossRefGoogle Scholar
30Steel, K, Ljunggren, G, Topinková, E, Morris, JN, Vitale, C, Parzuchowski, J, et al. (2003). The RAI-PC: an assessment instrument for palliative care in all settings. Am J Hosp Palliat Care, 20, 211–219.CrossRefGoogle ScholarPubMed
31Challiner, Y, Carpenter, GI, Potter, J, & Maxwell, C (2003). Performance indicators for hospital services for older people. Age Ageing, 32, 343–346.CrossRefGoogle ScholarPubMed
32Hirdes, JP, Dalby, DW, Steel, RK, Carpenter, GI, Bernabei, R, Morris, J, et al. (2006). Predictors of influenza immunization among home care clients in Ontario. Can J Pub Health, 97, 335–339.CrossRefGoogle ScholarPubMed
33Kane, RL (1990). RL, Kane, JG, Evans, & D, MacFayden. Introduction. Improving the health of older people: a world view. New York: University of Toronto Press.CrossRefGoogle Scholar
34Hirdes, JP, Naus, PJ, & Young, JE (1994). The use of preventive home visits among frail elderly persons: evidence from three European countries. Can J Aging, 13, 499–509.CrossRefGoogle Scholar
35Worrall, G, & Knight, J (2004). Our elderly population feels well: they are in control and not burdening their caregivers. Can Fam Physician, 50, 1662–1663.Google Scholar
36Newfoundland Department of Health. Projected operational requirements: Continuing Care Division. St. John's (Canada): Newfoundland Department of Health; (1997).Google Scholar
37Rosow, I (1997). Social integration of the aged. New York: Free Press.Google Scholar
38Stück, AE, Egger, M, Hammer, A, Minder, CE, & Beck, JC (2002). Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA, 287(8), 1022–1028.CrossRefGoogle ScholarPubMed
39Elkan, R, Kendrick, D, Dewey, M, Hewitt, M, Robinson, J, Blair, M, et al. (2001). Effectiveness of home-based support for older people: systematic review and meta-analysis. BMJ, 323, 1–9.CrossRefGoogle ScholarPubMed
40Meinck, M, Lubke, N, Lauterberg, J, & Robra, B-P (2004). Präventive Hausbesuche im Alter: eine systematische Bewertung der vorliegenden Evidenz [Preventive home visits to the elderly: systematic review of available evidence]. Gesundheitswesen, 66(11), 732–728.CrossRefGoogle Scholar
41McCusker, J, & Verdon, J (2006). Do geriatric interventions reduce emergency department visits? A systematic review. J Gerontol A Biol Sci Med Sci, 61(1), 53–62.CrossRefGoogle ScholarPubMed
42Stoltz, P, Udén, G, & Willman, A (2000). Support for family carers who care for an elderly person at home: a systematic literature review. Scand J Caring Sci, 18(2), 111–119.CrossRefGoogle Scholar