Purpose: This study aimed to test the effectiveness of High-Need Community-Dwelling Older Adults Care Delivery Model (HCOACDM) in Taiwan. Methods: A cluster randomized controlled trial with repeated measures design was conducted in eight community care centers, involving 145 high-need older adults who were assigned to the intervention group or comparison group. The HCOACDM was provided over 6 months. Functional ability, quality of life, depressive symptoms, and health care and social service utilizations were measured at baseline, at 3 months, and 6 months into the intervention. The participants’ satisfaction was measured at the end of 6-month intervention. Results: Positive effects were shown on all variables in the intervention group at both the 3-month and 6-month intervals (all p < .05). The intervention group had a higher satisfaction with care delivery than the comparison group ( p < .05). Discussion: The promising findings supported a long-term implementation of the HCOACDM as applicable and beneficial.

By early screening, the high-need older adults who require multiple care needs and resources can be identified and the necessary assistance can then be provided. However, a precise definition of and related research on high-need older adults are limited. Identifying older adults with high needs is of practical urgency. This study aimed to investigate the prevalence of high-need community-dwelling older adults and to identify the characteristic differences between high-need older adults and those without high needs. This cross-sectional descriptive survey research was conducted between July and December 2018 and used a simple random sampling to select older adults aged 65 and older who had lived in the community for at least 3 months. The High-need Community-dwelling Older Adults Screening Scale was used to identify high-need older adults in the community. A total of 818 communitydwelling older adults were surveyed and the prevalence of high-need older adults was 24.1%. Those screened as high-need older adults (n = 197) were 78.58 (SD = 7.60) years old in average, mostly female, widowed or single but living with someone, had chronic illnesses (M = 2.11, SD = 1.41), an elementary school level of education and religious beliefs. Furthermore, differences were found between older adults with high needs (n = 197) and those without high needs (n = 621) where there is a significantly higher proportion of high-need older adults who were 85 years and older, being male, widowed or single, illiterate, living alone, had chronic illnesses and no religious belief. The high prevalence of high-need community-dwelling older adults highlighted the importance of screening. If community care centres are provided with a comprehensive screening tool for finding high-need older adults during home visits, this would lead to timely identification of older adults with potential needs and enhance the preventive nature of home visits.

This study aimed to verify the factorial structure, internal consistency, test-retest reliability, and discriminant validity of the High-need Community-dwelling Older Adults Screening Scale (HCOASS). A 20-item HCOASS covering five domains was used with a systematic random sample of 818 community-dwelling older adults. After the analyses, the Exploratory Factor Analysis suggested a removal of two items, resulting in 5 domains with 18 items, and the Confirmatory Factor Analysis yielded satisfactory results with Goodness of Fit Index of .98. The HCOASS demonstrated acceptable internal consistency (Kuder-Richardson Formula 20 α = .75) and excellent test-retest reliability (0.94; 95% CI [0.91, 0.97]). The area under the Receiver Operating Characteristic (ROC) curve was 0.90 (95% CI [0.84, 0.95]) and the optimal cut-off score was 4/5. The HCOASS is a valid and reliable screening tool. It has the potential for consistent and efficient administration to be used by non-healthcare professionals in the community.