Home-based care reduces mortality, institutionalization risk in elderly

By Sarah Guy, medwireNews Reporter

Elderly individuals cared for at home under an intermediate care plan that focuses on high levels of support and rehabilitation are less likely to be relocated to an institution or to die than their peers who are treated with usual care, show study results from New Zealand.

Indeed, the composite of these outcomes was almost a third lower among those cared for under such initiatives versus usual care, note the researchers in Age and Ageing.

The team conducted a preplanned meta-analysis of data from three randomized trials involving 567 individuals aged 65 years or above from three areas (sites A, B, and C) of New Zealand given either usual care, or cared for in an initiative supporting older people's ability to continue living at home.

"The results from this study have important policy implications in that when well-developed intermediate care services are utilized, public concern around the potential risks faced by older people when remaining at home does not appear to be supported," say Matthew Parsons (The University of Auckland and Older Person Rehabilitation) and colleagues.

In all, 220 participants died or were admitted to a residential facility: in site A, 32 were from the usual care group compared with 26 from the intervention program; in site B, 30 incidents were from the usual care group while 22 were from the intervention group; and in site C, 66 incidents occurred among individuals given usual care versus 44 in an intermediate care plan.

The models developed at the three sites, while all slightly different, were established "to improve the relationship between the care managers and the participants' [general practitioner]," explain Parsons and team, and the success of the programs may have been a result of this shift.

Usual care consisted of ongoing community-based services or residential care.

After adjusting the data for potentially confounding factors including participants' needs levels, age, gender, and living situation (alone or with others), the combined primary outcome of death or residential entry was a significant 31% lower among all three care-managed models combined versus usual care.

Previous studies indicate that community care may achieve better outcomes at lower costs and be preferred by elderly people, even in terminal illness, to institutionalization, remark Parsons et al.

The current findings show that "when services are coordinated and configured appropriately, one's home can provide a safe and viable alternative to institutional care," the team concludes.

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