| Learning Objective #1: Describe what is known about the effectiveness of community preventive in-home health assessment and home-care programs for people aged over 75, in an international context | |||
| Learning Objective #2: Discuss a recent trial in Australia and some of the insights gained into the evaluation methodologies historically applied in this field of work |
One program recently trialled in Australia comprised • targeting before health and/or social crisis, while community care needs were low • linking clients with a community nurse • comprehensive health assessments and identification of needs • introduction of basic health care and community services and referrals if required • case management by three-monthly telephone contact for one year.
The sample consisted of 124 people aged over 75 years who lived alone in Independent Living Units, who were independent in activities of daily living. An experimental group (n=61) was compared with a control group (n=63) using a randomised control trial methodology. Numerous health outcomes were measured pre and post intervention.
Previously unidentified needs were found in 66% of the experimental group, and most needs were resolved. This group also showed a statistically significantly higher level of satisfaction with care, however the effect size was very small. Results showed no benefits were gained from the program for experimental group participants for the other outcomes of health perception, functional ability, psychosocial status, health resource utilisation and mortality.
This result was consistent with those of many other trials. Is it possible that methodological issues are masking many of the positive effects of the programs? Are the models being applied too broadly across a diverse elderly population? Are researchers expecting long-term outcomes in short time frames?