Interventions to delay institutionalization of frail older persons: design of a longitudinal study in the home care setting

Johanna De Almeida Mello, Therese Van Durme, Jean Macq, Anja Declercq, Johanna De Almeida Mello, Therese Van Durme, Jean Macq, Anja Declercq

Abstract

Background: Older people usually prefer staying at home rather than going into residential care. The Belgian National Institute for Health and Disability Insurance wishes to invest in home care by financing innovative projects that effectively help older people to stay at home longer. In this study protocol we describe the evaluation of 34 home care projects. These projects are clustered according to the type of their main intervention such as case management, night care, occupational therapy at home and psychological/psychosocial support. The main goal of this study is to identify which types of projects have the most effect in delaying institutionalization of frail older persons.

Methods/design: This is a longitudinal intervention study based on a quasi-experimental design. Researchers use three comparison strategies to evaluate intervention--comparison among different types of projects, comparisons between older persons in the projects and older persons not benefiting from a project but who are still at home and between older persons in the projects and older persons who are already institutionalized. Projects are asked to include clients who are frail and at risk of institutionalization. In the study we use internationally validated instruments such as the interRAI Home Care instrument, the WHO-QOL-8 and the Zarit Burden Interview-12. These instruments are filled out at baseline, at exit from the project and 6 months after baseline. Additionally, caregivers have to do a follow-up every 6 months until exit from the project. Criteria to exit the cohort will be institutionalization longer than 3 months and death. The main analysis in the study consists of the calculation of incidence rates, cumulative incidence rates and hazard rates of definitive institutionalization through survival analyses for each type of project.

Discussion: This research will provide knowledge on the functional status of frail older persons who are still living at home. This is important information to identify determinants of risk for institutionalization. The identification of effective home care projects in delaying institutionalization will be useful to inform and empower home care providers, policy and related decision makers to manage and improve home care services.

References

    1. Hellström Y, Hallberg IR. Perspectives of elderly people receiving home help on health, care and quality of life. Health Soc Care Community. 2001;9:61–71. doi: 10.1046/j.1365-2524.2001.00282.x.
    1. Zank S, Schacke C. Evaluation of geriatric day care units: effects on patients and caregivers. J Gerontol B Psychol Sci Soc Sci. 2002;57:348–357.
    1. Benjamin AE. A normative analysis of home care goals. J Aging Health. 1999;11(Supplem 3):445–468. Aug.
    1. Knight S, Tjassing H. Health care moves to the home. World Health. 1994;4:413–444.
    1. Thomé B, Dykes AK, Hallberg IR. Home care with regard to definition, care recipients, content and outcome: systematic literature review. J Clin Nurs. 2003;12:860–872. doi: 10.1046/j.1365-2702.2003.00803.x.
    1. Rechel B, Doyle Y, Grundy E, McKee M. How can health systems respond to population ageing? WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies: Copenhagen; 2009. (Health Systems and Policy Analysis Brief No. 10).
    1. Coughlin T, McBride T, Perozek M, Liu K. Home Care for the Disabled Elderly: Predictors and Expected Costs. Health Serv Res. 1992;27(4):453–479.
    1. Hutt R, Rosen R, McCauley J. Case-managing long-term conditions: what impact does it have in the treatment of older people? London: King's Fund; 2004. Top of Form 1.
    1. Hendriksen C, Lund E, Stromgard E. Consequences of assessment and intervention among elderly people: a three year randomized controlled trial. Br Med J. 1984;289:1522–1524. doi: 10.1136/bmj.289.6457.1522.
    1. Bernabei R, Landi F, Gambassi G. et al.Randomized trial of impact of model of integrated care and case management for older people living in the community . Br Med J. 1998;316:1348–1351. doi: 10.1136/bmj.316.7141.1348.
    1. Van den Bosch K, Willemé P, Geerts J, Breda J, Peeters S, Van De Sande S, Vrijens F, Van de Voorde C, Stordeur S. Toekomstige behoefte aan residentiële ouderenzorg in België: Projecties 2011–2025. Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE): Health Services Research (HSR); 2011. KCE Reports 167A./2011/10.273/63.
    1. IRSS - Université catholique de Louvain, LUCAS - Katholieke Universiteit Leuven, Université de Liège, PICA - Universiteit Antwerpen. Protocol for the scientific evaluation of alternative projects of care and support of care for frail elderly (adaptation of the initial protocol) Belgium: National Institute of Health Disability Insurance; 2011. p. 99. unpublished.
    1. Conférence interministérielle. Avenant n°3 au Protocole d'accord n°3 du 13 June 2005, conclu entre l'Autorité fédérale et les Autorités visées aux articles 128, 130, 135 et 138 de la Constitution, concernant la politique de santé à mener à l'égard des personnes âgées et qui concerne les formes alternatives de soins et de soutien aux soins. Moniteur Belge: Services Public Fédéral Santé Publique, Sécurité de la Chaine Alimentaire et Environnement; 2008. pp. 41009–41018. unpublished.
    1. Ribesse N, Swine C, Macq J. An evaluation protocol of primary care interventions aimed to support frail elderly living at home. J Nutr Health Aging. 2009;13(Suppl 1):S97.
    1. K.B. 2-7-2009: tot vaststelling van de voorwaarden waaronder het Verzekeringscomité met toepassing van artikel 56, par. 2, eerste lid, 3°, van de wet betreffende de verplichte verzekering voor geneeskundige verzorging en uitkeringen, gecoördineerd op 14 juli 1994, overeenkomsten kan sluiten voor de financiering van alternatieve en ondersteunende zorg voor kwetsbare ouderen, unpublished.
    1. Grimshaw J, Campbell M, Eccles M, Steen I. Experimental and quasi-experimental designs for evaluating guideline implementation strategies. Fam Pract. 2000;17:S11–S18. doi: 10.1093/fampra/17.suppl_1.S11.
    1. Rolfson D, Majumdar S, Tsuyuki R. et al.Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35:526–529. doi: 10.1093/ageing/afl041.
    1. Protocol 3 consortium of researchers; Implementation Analysis - Intermediate Report. 2011. unpublished.
    1. De Lepeleire J, Hiffe S, Mann E, Degryse JM. Frailty: an emerging concept for general practice. Br J Gen Pract. 2009;59:e177–e182. doi: 10.3399/bjgp09X420653.
    1. Omzendbrief aan de verpleegkundigen 2006/4. Dienst voor Geneeskundige Verzorging. RIZIV. 1240/OMZ-CIRC/INF-06-4N Brussel, unpublished.
    1. Belgische Burgerlijk Wetboek - Art. pp. 487–488. and 489.
    1. Beraadslaging nr. 10/028 van 20 April 2010 met betrekking tot de verwerking van persoonsgegevens die de gezondheid betreffen voor de evaluatie van projecten in het kader van het Protocolakkoord nr. 3.
    1. Landi F, Tua E, Onder G, Carrara B, Sgadari A, Rinaldi C. The Minimum Data Set for Home Care: a valid instrument to assess frail older people living in community. Med Care. 2000;30:1184–1190.
    1. WHOQOL Group. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–558.
    1. WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41:1403–1409.
    1. Bedard M, Molloy DW, Squire L, Dubois S, Lever JA, O'Donnell M. The Zarit Burden Interview: a new short version and screening version. Gerontologist. 2001;41(Supplem 5):652–657. October.
    1. Landi F, Gambassi G, Pola R, Tabaccanti S, Cavinato T, Carbonin PU, Bernabei R. Impact of Integrated Home Care Services on Hospital Use. J Am Geriatr Soc. 1999;47:1430–1434.
    1. Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V, Rubenstein L, Carbonin PU. Randomized trial of impact of model of integrated care and case management for older people living in the community. BMJ. 1998;316(7141):1348–1351. doi: 10.1136/bmj.316.7141.1348. Clinical Research Ed.
    1. Berg K, Finne-Soveri H, Gray L, Henrard JC, Hirdes J, Ikegami N. et al.Relationship between interRAI HC and the ICF: opportunity for operationalizing the ICF. BMC Health Serv Res. 2009;9:47. doi: 10.1186/1472-6963-9-47.
    1. Schmidt S, Mühlan H, Power M. EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study. Eur J Public Health. 2006;16:420–428. doi: 10.1093/eurpub/cki155.
    1. Nosikov A, Gudex C. EUROHIS: Developing Common Instruments for Health Surveys. Amsterdam: IOS Press. 2003;57:145–163.
    1. WHO. SAGE Survey Programme. 2010. Available from: .
    1. Etters L, Goodall D, Harrison BE. Caregiver burden among dementia patient caregivers: A review of the literature. J Am Acad Nurse Pract. 2008;20:423–428. doi: 10.1111/j.1745-7599.2008.00342.x.
    1. Papastavrou E, Kalokerinou A, Papacostas SS, Tsangari H, Sourtzi P. Caring for a relative with dementia: family caregiver burden. J Adv Nurs. 2007;2007(58):446–457. doi: 10.1111/j.1365-2648.2007.04250.x.
    1. Bull MJ, Bowers JE, Kirschling JM, Neufeld A. Factors Influencing Family Caregiver Burden and Health. West J Nurs Res. 1990;12:758. doi: 10.1177/019394599001200605.
    1. Morris J, Carpenter I, Berg K, Jones RN. Outcome measures for use with home care clients. Can J Aging. 2000;19(2):87–105. doi: 10.1017/S071498080001391X.
    1. Morris J, Fries B, Morris S. Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci. 1999;54(11):M546–M553. doi: 10.1093/gerona/54.11.M546.
    1. Morris J, Fries BE, Mehr DR, Hawes C, Phillips CD, Mo V. MDS Cognitive Performance Scale. J Gerontol. 1994;49:4. Jul.
    1. Hartmaier S, Sloane P, Guess H, Koch GG, Mitchell M, Phillips CD. Validation of the minimum data set cognitive performance scale: Agreement with the mini-mental state examination. Journal of Gerontology: Medical Sciences. 1995;50A(2):M128–M133. doi: 10.1093/gerona/50A.2.M128.
    1. Frederiksen K, Tariot P, De Jonghe E. Minimum Data Set Plus (MDS+) scores compared with scores from five rating scales. J Am Geriatr Soc. 1996;44(3):305–309.
    1. Gruber-Baldini AL, Zimmerman SI, Mortimore E, Magaziner J. The validity of the Minimum Data Set in measuring the cognitive impairment of persons admitted to nursing homes. J Am Geriatr Soc. 2000;48:1601–1606.
    1. Fox J. Cox proportional-hazard regression for survival data. An R and S-PLUS companion to applied regression. 2002;2002 Sage Publications.
    1. Miller Rupert G. Survival analysis. New York (N.Y.): Wiley; 1981.
    1. Cleves M, Gould W, Gutierrez RG, Marchenko Y. An introduction to survival analysis using stata. Texas: Stata Corporation; 2010.
    1. Hirdes JP, Poss JW, Curtin-Telegdi N. The Method for Assigning Priority Levels (MAPLe): a new decision-support system for allocating home care resources. BMC Med. 2008;6:9. doi: 10.1186/1741-7015-6-9.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する