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Randomized Trial of a Health Promotion Program For Frail Elders*

Published online by Cambridge University Press:  29 November 2010

Nancy Hall
Affiliation:
North Shore Health Department
Paula De Beck
Affiliation:
B.C. Ministry of Health
Debra Johnson
Affiliation:
B.C. Ministry of Health
Kelly Mackinnon
Affiliation:
B.C. Ministry of Health
Gloria Gutman
Affiliation:
Simon Fraser University
Ned Glick
Affiliation:
University of British Columbia

Abstract

This study evaluates a local health promotion project that may be widely adaptable to assist frail elderly persons to live longer at home. Subjects, enrolled in New Westminster, B.C., were men and women aged 65 and over living in their own homes but assessed and newly admitted to “personal care at home” by the Long Term Care (LTC) program of the B.C. Ministry of Health. About 90 per cent of eligible clients consented to participate. Randomized to Treatment or Control, they were followed for three years. Controls (n = 86) received standard LTC services, which included screening and pre-admission assessment, arrangement/purchase of needed services and review at three months and at least yearly thereafter. The Treatment group (n = 81) received standard LTC services plus visits from the project nurse who helped each subject to devise a personal health plan based on his or her needs in the areas of health care, substance use, exercise, nutrition, stress management, emotional functioning, social support and participation, housing, finances and transportation. The visits concentrated on setting goals and developing personal health skills, with referral to appropriate community services. An additional group of LTC clients (n = 81) from the adjacent community of Coquitlam was also followed. Success or “survival” was defined as “alive and still assessed for care at home”. After three years the “survival rate” for the Treatment group was 75.3 per cent, compared with 59.3 per cent for the Control group and 58.0 per cent for the Coquitlam group. Standard Kaplan-Meier “survival” graphs show that Treatment subjects were more likely to be alive and living at home at every time point during the three years. Differences between the Treatment and Control groups were statistically significant (p ≤ 0.05) both for simple cross-tabulations of care status at 24 and 36 months and in tests comparing “survival” curves. The results are especially striking because Control subjects received LTC services in a geographic area that offers universal access to health care and community resources and because the Control data were concurrent, not historical.

Résumé

Cette étude évalue un projet local de promotion de la santé, destiné à venir en aide aux personnes âgées vulnérables vivant encore à domicile. Ce projet peut être transposé sur une grande échelle. Les sujets, sélectionnés à New-Westminster, B.C., étaient des hommes et des femmes âgés de soixante-cinq ans et plus et demeurant chez eux. Toutefois, après évaluation, ils ont été récemment admis aux soins personnels à domicile – un élément du programme de soins de longue durée du ministère de la Santé de Colombie-Britannique. Environ 90 pour cent des clients admissibles ont accepté de participer à la recherche qui s'est échelonnée sur trios ans. Le groupe-témoin (86 personnes) bénéficiait de services réguliers, au terme du programme de soins de longue durée, ce qui incluait d'une part la selection et l'évaluation de préadmission et d'autre part l'obtention des services requis avec révision trimestrielle et minimalement annuelle par la suite. Le groupe expérimental (n = 81) en plus de bénéficier de ces services recevait des services des infirmières rattachées au projet, qui aidaient les sujets à concevoir un plan personnel de santé fondé sur leurs besoins dans les domaines suivants: les soins de santé, l'usage des médicaments, l'exercice, la nutrition, la gestion du stress, le fonctionnement émotif, le support social, le degré de participation sociale, le logement, les finances et les transports. Les visites étaient centrées sur des objectifs comme par exemple des rôles à déterminer, des habiletés à développer en terme de santé, sans oublier des références aux services communautaires. Enfin, un autre groupe (n = 81) relevant du programme de soins à long terme, et appartenant au district voisin de Coquitlam, a été suivi. La définition du succès ou de la « survie » était la suivante: « vivant et encore évalué comme cas de soins a domicile ». Après trois ans, le «taux de survie » pour le groupe expérimental était de 75.3 pour cent, comparé à 59.3 pour cent pour le groupe-témoin et 58 pour cent pour le groupe de Coquitlam. Les courbes de survie de Kaplan-Meier montrent que les sujets du groupe expérimental étaient davantage susceptible de rester en vie et de vivre à la maison, en tout temps, au cours de ces trois années. Les différences entre le groupe expérimental et le groupe témoin étaient, statistiquement parlant, significatives (p ≤ 0.05) tant pour les tableaux bivariés concernant l'état des soins aux 24 et aux 36 mois, que pour les tests qui comparaient les courbes de survie. Les résultats sont particulièrement frappants car les sujets du groupe témoin bénéficiaient des services de soins à long terme dans une région qui offre une accessibilité complète aux soins de santé et aux ressources communautaires et parce que les données concernant le groupe témoin avaient un caractère simultané et non ponctuel.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 1992

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