The evidence for services to avoid or delay residential aged care admission: a systematic review
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, ag...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-08-01
|
| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12877-019-1210-3 |
| _version_ | 1830451354554859520 |
|---|---|
| author | Julie A. Luker Anthea Worley Mandy Stanley Jeric Uy Amber M. Watt Susan L. Hillier |
| author_facet | Julie A. Luker Anthea Worley Mandy Stanley Jeric Uy Amber M. Watt Susan L. Hillier |
| author_sort | Julie A. Luker |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T08:31:41Z |
| format | Article |
| id | doaj.art-29d60df3f5424f8898240ecbee318717 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-21T08:31:41Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-29d60df3f5424f8898240ecbee3187172022-12-21T19:10:10ZengBMCBMC Geriatrics1471-23182019-08-0119112010.1186/s12877-019-1210-3The evidence for services to avoid or delay residential aged care admission: a systematic reviewJulie A. Luker0Anthea Worley1Mandy Stanley2Jeric Uy3Amber M. Watt4Susan L. Hillier5Division of Health Sciences, University of South AustraliaDivision of Health Sciences, University of South AustraliaDivision of Health Sciences, University of South AustraliaDivision of Health Sciences, University of South AustraliaECH IncorporatedDivision of Health Sciences, University of South AustraliaAbstract 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.http://link.springer.com/article/10.1186/s12877-019-1210-3Aging in placeCommunity dwellingIndependent livingHealth servicesCommunitySystematic review |
| spellingShingle | Julie A. Luker Anthea Worley Mandy Stanley Jeric Uy Amber M. Watt Susan L. Hillier The evidence for services to avoid or delay residential aged care admission: a systematic review BMC Geriatrics Aging in place Community dwelling Independent living Health services Community Systematic review |
| title | The evidence for services to avoid or delay residential aged care admission: a systematic review |
| title_full | The evidence for services to avoid or delay residential aged care admission: a systematic review |
| title_fullStr | The evidence for services to avoid or delay residential aged care admission: a systematic review |
| title_full_unstemmed | The evidence for services to avoid or delay residential aged care admission: a systematic review |
| title_short | The evidence for services to avoid or delay residential aged care admission: a systematic review |
| title_sort | evidence for services to avoid or delay residential aged care admission a systematic review |
| topic | Aging in place Community dwelling Independent living Health services Community Systematic review |
| url | http://link.springer.com/article/10.1186/s12877-019-1210-3 |
| work_keys_str_mv | AT juliealuker theevidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT antheaworley theevidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT mandystanley theevidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT jericuy theevidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT ambermwatt theevidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT susanlhillier theevidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT juliealuker evidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT antheaworley evidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT mandystanley evidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT jericuy evidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT ambermwatt evidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview AT susanlhillier evidenceforservicestoavoidordelayresidentialagedcareadmissionasystematicreview |