Network-based rehabilitation increases formal support of frail elderly home-dwelling persons in Finland: randomised controlled trial

What is known about the topic• There is policy commitment to closer working between professionals to improve health and social care but the benefits of this are poorly understood at the user ⁄ patient level.• Language and terminology used to capture the process of interprofessional working are imprecise.• There is little evidence linking interprofessional working to explicit outcomes for older people.• It is not clear how different contexts, systems, professionals, agencies, roles and services influence the effectiveness of inter-professional working. What this paper adds• There are different ways to document the process of interprofessional working.• Studies should measure effectiveness and cost effectiveness of interprofessional working.• Integrated models of inter-professional working have the potential to improve processes of care and to reduce hospital use or long-term care moves. AbstractHealth and social care policy in the UK advocates inter-professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990-31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user-relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (interventions delivering acute, chronic, palliative and preventive care) identified within each model of IPW. We retrieved 3211 records and included 37 RCTs which were mapped onto the IPW models: Overall, there is weak evidence of effectiveness and cost-effectiveness for IPW, although well-integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing ⁄ care home use. Study quality varied considerably and high quality evaluations as well as observational studies are needed to identify the key components of effective IPW in relation to user-defined outcomes. Differences in local contexts raise questions about the applicability of the findings and their implications for practice. We need more information on the outcomes of the process of IPW and evaluations of the effectiveness of different configurations of health and social care professionals for the care of community dwelling older people.

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“…Four studies covered chronic care: one of good quality, targeted people at high risk of ‘institutionalisation’ (Ollonqvist et al. 2008).…”

Section: Resultsmentioning

confidence: 99%

“…The South Australian Health Plus trial targeting diverse patient groups reported improved physical function in the intervention group over time (Battersby 2005, Battersby et al. 2007), whereas a network rehabilitation model showed no effect on function but improved subjective health (Ollonqvist et al. 2008).…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of inter-professional working for older people living in the community: a systematic review

Trivedi

Goodman

Gage

et al. 2012

Health &Amp; Social Care in the Community

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“…The meetings focused on health promotion and control. One intervention (Ollonqvist et al 2008) contains three inpatient rehab periods with individual and group sessions plus home activation days and home visits for personal hygiene and assistive devices. Liang et al (1986) used a stepped-up treatment (on top of nursing and social services) provided by a physician and physical therapist focusing on assistive devices and home modification and supervised exercises.…”

Section: Other Interventions (N = 6)mentioning

confidence: 99%

Interventions to prevent disability in frail community-dwelling older persons: an overview

et al. 2010

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This narrative review was conducted to provide an overview of the variety of interventions aimed at disability prevention in community-dwelling frail older persons and to summarize promising elements. The search strategy and selection process found 48 papers that met the inclusion criteria. The 49 interventions described in these 48 papers were categorized into 'comprehensive geriatric assessment', 'physical exercise', 'nutrition', 'technology', and 'other interventions'. There is a large diversity within and between the groups of interventions in terms of content, disciplines involved, duration, intensity, and setting. For 18 of the 49 interventions, significant positive effects for disability were reported for the experimental group. Promising features of interventions seem to be: multidisciplinary and multifactorial, individualized assessment and intervention, case management, long-term follow-up, physical exercise component (for moderate physically frail older persons), and the use of technology. Future intervention studies could combine these elements and consider the addition of new elements.

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“…In its multidimensional aspect, this support can be classified according to its characteristics: direction (received or offered); disposition (availability or execution); way of measurement (described or evaluated); content (emotional, instrumental, informative, evaluative); social network (family, friends, neighbors, work colleagues, the community, and other) (10) . Besides that, two different social support modalities still need to be considered: the formal support (support system offered/provided by the State and institutions), that has an infrastructure with the specific purpose of support in certain areas and which utilize professionals or volunteers to reach their goals; and the informal support (offered/provided by the family, neighbors, friends, and community), motivated by feelings of affection or obligation (13)(14) . According to the Human Development Report of 1999 (15) , the social support acts as a fundamental role in the formation of human capabilities and in human development.…”

Section: Introductionmentioning

confidence: 99%

Apoio social entre idosas de uma localidade de baixa renda no Munícipio do Rio de Janeiro

2010

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Objective: To identify the perceived availability and provision of informal and formal social support among elderly women in a low income area of the municipality of Rio de Janeiro. Methods: This is descriptive and cross-sectional study; done by using household survey with 369 (83.5%) elderly in the community. Results: Elderly women had an adverse social condition (49.3% were illiterate, 71.3% had no partner, 62.3% reported a monthly income of up to minimum wage and 22.0% had no income.) The most common informal types of support were: money, personal care and companionship for locomotion. However, they relied on the care of grandchildren, housing and money. Only 20% reported receiving support from the state or institutions, most of them as basic food. The three main sources of formal supports were: the municipal government, the church and, the state government. Conclusion: The trade of relations had more weight on the side of the older, because the when the elderly cares for their grandchildren, the parents could work and thus increase the household income. Descriptors: Health of the elderly; Social support; Aging; Cross-sectional studies; Women's health RESUMOObjetivo: Identificar a percepção de disponibilidade e oferta de apoio social informal e formal entre idosas de uma localidade de baixa renda do Município do Rio de Janeiro. Métodos: Estudo descritivo, de corte seccional realizado por meio de inquérito domiciliar com 369 (83,5%) idosas da comunidade. Resultados: As mulheres tinham condição social desfavorável (49,3% eram não letrados, 71,3% não tinham companheiro, 62,3% referiram renda mensal de até um salário mínimo e 22,0% não tinham renda). Os tipos de apoio informais mais recebidos foram dinheiro, cuidado pessoal e companhia para se locomover. No entanto, elas se apoiavam no cuidado dos netos, moradia e dinheiro. Apenas 20% declararam receber apoio do Estado ou instituições, destacando-se, sobretudo, a cesta básica. As três principais fontes desses apoios formais foram: governo municipal, Igreja e governo estadual. Conclusão: O fluxo das relações de troca foi maior no sentido das idosas para suas famílias do que o contrário. Ao cuidar dos netos, as idosas possibilitavam que seus filhos trabalhem e, consequentemente, aumentem a renda familiar. Descritores: Saúde do idoso; Apoio social; Envelhecimento; Estudos transversais; Saúde da mulher RESUMEN Objetivo: Identificar la percepción de disponibilidad y ofrecimiento de apoyo social informal y formal entre ancianas de una localidad de baja renta del Municipio de Rio de Janeiro. Métodos: Se trata de un estudio descriptivo, de corte seccional, realizado por medio de encuesta domiciliar con 369 (83,5%) ancianas de la comunidad. Resultados: Las mujeres tenían una condición social desfavorable (49,3% eran analfabetas, 71,3% no tenían compañero, 62,3% informaron una renta mensual de hasta un salario mínimo y 22,0% no tenían renta). Los tipos de apoyo informales más frecuentes fueron dinero, cuidado personal y compañía para la locomoción. Sin embargo, ell...

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Network-based rehabilitation increases formal support of frail elderly home-dwelling persons in Finland: randomised controlled trial

Cited by 16 publications

References 43 publications

The effectiveness of inter-professional working for older people living in the community: a systematic review

The effectiveness of inter-professional working for older people living in the community: a systematic review

Interventions to prevent disability in frail community-dwelling older persons: an overview

Apoio social entre idosas de uma localidade de baixa renda no Munícipio do Rio de Janeiro

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