Aging at Home: Integrating Community-Based Care for Older Persons

Lum, Janet; Deber, Raisa; Montgomery, R. E.; Kuluski, Kerry; Peckham, Allie; Watkins, Jillian; Williams, A. Paul; Ying, Alvin; Zhu, Lynn

doi:10.12927/hcpap.2009.21218

Cited by 41 publications

(40 citation statements)

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“…Many elderly people prefer and choose to age at home [38–42]. Healthcare organizations and policy makers are increasingly challenged to better support a shift from institutionalized long-term care to support elders to remain in their community [43]. The included reviews indicate a growing literature of interventions designed to promote health, function and independent living among community dwelling elders.…”

Section: Discussionmentioning

confidence: 99%

Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews

et al. 2017

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BackgroundMany elders struggle with the decision to remain at home or to move to an alternative location of care. A person’s location of care can influence health and wellbeing. Healthcare organizations and policy makers are increasingly challenged to better support elders’ dwelling and health care needs. A summary of the evidence that examines home care compared to other care locations can inform decision making. We surveyed and summarized the evidence evaluating the impact of home care versus alternative locations of care on elder health outcomes.MethodsWe conducted an overview of systematic reviews. Data sources included MEDLINE, the Cochrane Library, EMBASE, and CINAHL. Eligible reviews included adults 65+ years, elder home care, alternative care locations, and elder health outcomes. Two independent reviewers screened citations. We extracted data and appraised review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. Results were synthesized narratively.ResultsThe search yielded 2575 citations, of which 19 systematic reviews were eligible. Three hundred and forty studies with 271,660 participants were synthesized across the systematic reviews. The categories of comparisons included: home with support versus independent living at home (n = 11 reviews), home care versus institutional care (n = 3 reviews), and rehabilitation at home versus conventional rehabilitation services (n = 7 reviews). Two reviews had data relevant to two categories. Most reviews favoured home with support to independent living at home. Findings comparing home care to institutional care were mixed. Most reviews found no differences in health outcomes between rehabilitation at home versus conventional rehabilitation services. Systematic review quality was moderate, with a median AMSTAR score of 6 (range 4 - 10 out of 11).ConclusionsThe evidence on the impact of home care compared to alternative care locations on elder health outcomes is heterogeneous. Our findings support positive health impacts of home support interventions for community dwelling elders compared to independent living at home. There is insufficient evidence to determine the impact of alternative care locations on elders’ health. Additional research targeting housing and care options for the elderly is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0395-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews

et al. 2017

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“…Integration of services provided by expert HF clinicians with primary care providers represents another opportunity for system integration and collaboration. Despite some significant structural and philosophical difference among various models of care, common features of effective integrated systems of care have been identified and are summarized elsewhere [184,185,[193][194][195][196].…”

Section: System Integrationmentioning

confidence: 99%

The older patient with heart failure: high risk for frailty and cognitive impairment

Harkness

Heckman

McKelvie

2012

Expert Review of Cardiovascular Therapy

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Managing older heart failure (HF) patients can be complicated by both cardiac and noncardiac conditions. Over the past 20 years, care for HF patients has become more complex, with a rising proportion of older people living with HF. In particular, cognitive impairment (CI) and frailty often coexist with HF in the elderly. With the prevalence of HF, frailty and cognitive impairment rising with age, the simultaneous occurrence of at least two of these conditions in the same individual will become more frequent. The presence of frailty and/or cognitive impairment in older people with HF is independently associated with worse clinical outcomes. The purpose of this review is to provide an overview of frailty and cognitive impairment in older HF patients. Specifically, this article describes the epidemiology of these conditions in HF patients, outlines potential underlying mechanisms, highlights relevant screening tools and reviews relevant clinical implications.

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“…One notable response to cost containment pressures relating to the delivery of care for older Canadians has been the introduction of new policies that support aging at home. These policies have effectively shifted care from ostensibly more costly acute care settings to the HCC and LTC sectors [7]. The consequent increase in demand for HCAs has been amplified by the concurrent trend to substitute higher cost regulated workers, like nurses, with lower cost unregulated workers [8-10].…”

Section: Introductionmentioning

confidence: 99%

The evolving role of health care aides in the long-term care and home and community care sectors in Canada

et al. 2013

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Health Care Aides (HCAs) provide up to 80% of the direct care to older Canadians living in long term care facilities, or in their homes. They are an understudied workforce, and calls for health human resources strategies relating to these workers are, we feel, precipitous. First, we need a better understanding of the nature and scope of their work, and of the factors that shape it. Here, we discuss the evolving role of HCAs and the factors that impact how and where they work. The work of HCAs includes role-required behaviors, an increasing array of delegated acts, and extra-role behaviors like emotional support. Role boundaries, particularly instances where some workers over-invest in care beyond expected levels, are identified as one of the biggest concerns among employers of HCAs in the current cost-containment environment. A number of factors significantly impact what these workers do and where they work, including market-level differences, job mobility, and work structure. In Canada, entry into this ‘profession’ is increasingly constrained to the Home and Community Care sector, while market-level and work structure differences constrain job mobility to transitions of only the most experienced workers, to the long-term care sector. We note that this is in direct opposition to recent policy initiatives designed to encourage aging at home. Work structure influences what these workers do, and how they work; many HCAs work for three or four different agencies in order to sustain themselves and their families. Expectations with regard to HCA preparation have changed over the past decade in Canada, and training is emerging as a high priority health human resource issue. An increasing emphasis on improving quality of care and measuring performance, and on integrated team-based care delivery, has considerable implications for worker training. New models of care delivery foreshadow a need for management and leadership expertise - these workers have not historically been prepared for leadership roles. We conclude with a brief discussion of the next steps necessary to generating evidence necessary to informing a health human resource strategy relating to the provision of care to older Canadians.

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Aging at Home: Integrating Community-Based Care for Older Persons

Cited by 41 publications

References 0 publications

Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews

Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews

The older patient with heart failure: high risk for frailty and cognitive impairment

The evolving role of health care aides in the long-term care and home and community care sectors in Canada

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