Residential care intervention program in the elderly

As more people enter long-term institutional care; innovative models of medical service delivery will be imperative, to promote best practice for residents whilst containing healthcare costs [ 2 ]. There is considerable international interest in alternative models of care for long-term RCF residents [ 10 , 11 ].

The Netherlands has successfully trialled the use of RCF physicians with specialist training in nursing home medicine and have demonstrated improvements in the quality of care provided within RCF [ 10 ].

In the US interventions to up-skill RCF staff in the assessment and management of acute inter-current illness have reduced acute care transfers from RCF facilities [ 11 ]. These successes demonstrate that medical management of RCF patients can be improved, placing the challenge on local health care administrators to develop models of care that are efficacious and applicable to their local context.

The proportion of adults dying within residential aged care facilities RCF is also rising. When ACP discussions are backed up by formal documentation of AD this can facilitate decision making at a future crisis point, easing the burden on family, and care providers [ 13 ]. Despite the willingness of older adults to discuss their preferences for end-of-life care and the benefits of formally documented AD, its uptake in RCF has been relatively low [ 17 , 18 ].

The Residential Care Intervention Program in the Elderly RECIPE service is based in outer metropolitan Melbourne, Australia and provides expert comprehensive assessment and management by geriatricians and aged care nurse specialists to individuals living in RCF who are at imminent risk of requiring acute care management.

In the hospital aged care unit established the service and promoted it to RCFs and general practitioners GPs in their catchment area. At this time, local RCFs had limited access to primary care physicians, ACP was not widely promoted in RCF and there were few alternatives to ED attendance for management of acute illness outside standard office hours. It was anticipated that if these aims were achieved then emergency department attendances would also be decreased. When the service was established, a comprehensive health service evaluation was undertaken to evaluate the feasibility, acceptability to consumers, and the potential of this model of care to decrease acute health care utilisation.

This paper presents the findings of a preliminary study which evaluated both the feasibility of the geriatrician-led, in-reach service and of conducting a randomised controlled trial RCT to evaluate this model of care [ 19 , 20 ].

In —04 we conducted a randomised controlled trial of a supported discharge intervention for patients aged 65 years or older admitted to hospital from RCF in outer metropolitan Melbourne, Australia. To efficiently utilise limited resources the patient rather than the facility was chosen as the unit of randomisation. Patients being discharged to RCF were invited to participate during their index hospital admission and were followed for six-months. Patients were excluded if they were less than 65 years of age, were not living permanently in RCF, had already been enrolled, had non-medical primary diagnoses, were expected to die during their index admission, lived outside the health service catchment area, exhibited severe behavioural disturbance, or consent was not obtained for study participation.

Patients were randomised in a ratio using a computer generated random number sequence and study allocations were placed in pre-numbered, sealed envelopes. The study team allocated each patient to the next consecutive number at discharge from acute care. They had no control over the timing of discharges, and the treating medical units were blinded to the study allocation. Ethics approval was obtained from the Northern Health Human Research Ethics Committee and written informed consent was obtained from competent patients or the person responsible if the patient lacked capacity.

All intervention group patients were reviewed in the RCF within four days of discharge. At the first visit, a comprehensive assessment and a tailored care plan was developed.

Appropriate services were provided and patients were offered further visits for review of intercurrent illness if required. The usual care group was managed by the treating medical unit according to standard hospital protocols and received standard discharge planning, with follow-up at the RCF by their primary care physician service.

Barthel Index [ 23 ] was used to measure physical function, and Short Zung Interviewer-assisted Depression Scale [ 24 ] was used to assess mood. Both groups were visited by the research team three times over six months for data collection. The Barthel Index, the number of medications and number of co-morbidities were used as proxy measures of illness severity and frailty amongst residents.

Administrative data was obtained on utilisation of hospital-based clinical services including: inpatient admission acute or sub-acute , outpatient and day procedure visits. Surveys were distributed to patients where appropriate and family members from both intervention and control groups. Participants were asked to provide feedback on their satisfaction with the service and whether geriatrician-led care in the RCF provided an alternative to hospital-based care. The surveys were distributed with a stamped, self-addressed envelope within four weeks of the six month discharge visit, or death.

Categorical data was summarised using means and percentages and continuous data using mean, standard deviation SD and range. Categorical outcomes were compared between groups using chi square tests and logistic regression and continuous variables were compared using independent sample t-tests.

An interim analysis of the study results was conducted at 18 months to review the feasibility of the service and the appropriateness of the evaluation strategy. At this time point patients had been randomised into the study. Over 18 months, patients were screened and excluded.

Of the study participants, 57 patients were randomised to the intervention group and 59 patients to usual care. Participants were spread across 45 facilities and primary care was provided by more than 60 GPs. Intervention group patients were younger mean age There were no significant differences between groups in quality of life at baseline and no significant changes within either group over time. There was no significant difference in age, hospital length of stay, number of medications, co-morbidities, depression scores or study group between survivors and non-survivors.

Survivors had better cognition scores mean MMSE The mean time from enrolment in the service to written AD documentation was 40 days, range 0 to Patient recruitment was slower than expected mainly due to difficulties in obtaining written informed consent. Important note: Do not send applications to the Provider Enrollment Division. Page Content. Provision and oversight of personal and supportive services. Transportation or arrangement of transportation.

Provider Resources, Forms, and Memorandums. It is unclear whether this approach is beneficial for the frailest older adults living in permanent residential care. This study was undertaken to evaluate 1 the feasibility and consumer satisfaction with a geriatrician-led supported discharge service for older adults living in residential care facilities RCF and 2 its impact on the uptake of Advanced Care Planning ACP and acute health care service utilisation.

Methods: In a randomised controlled trial was conducted in Melbourne, Australia comparing the geriatrician-led outreach service to usual care for RCF residents.

Conclusions: Multifaceted programs that encompass a wide range of intervention strategies have shown some evidence of efficacy. However, more well-designed research is required that assesses effects on injurious falls, quality of life, cost-effectiveness, and sustainability. Abstract Background: Unintentional falls are particularly prevalent among older people and constitute a public health concern.

Publication types Review.