Systematic Review of Outcomes from Home‐Based Primary Care Programs for Homebound Older Adults

Stall, Nathan M.; Nowaczynski, Mark; Sinha, Samir K.

doi:10.1111/jgs.13088

Cited by 172 publications

(208 citation statements)

References 39 publications

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“…Many models of HBPC are emphasizing the importance of palliative approaches for people with complex chronic illnesses. Evidence in non-homebound elders suggests that for older primary care patients, interventions such as in-home palliative care programs and “symptom treatment” protocols can lead to significant symptom improvement, higher satisfaction with services, and reductions in health care utilization (23, 48, 53–56). Further study should specifically assess if effective symptom management has a similar impact in the homebound.…”

Section: Discussionmentioning

confidence: 99%

Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound

Yang

Ornstein

Reckrey

2016

Journal of Pain and Symptom Management

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CONTEXT Homebound adults experience significant symptom burden. OBJECTIVES (1) To examine demographic and clinical characteristics associated with high symptom burden in the homebound, and (2) to examine associations between symptom burden and time to hospitalization, nursing home placement, and death. METHODS 318 patients newly enrolled in the Mount Sinai Visiting Doctors Program, an urban home-based primary care program, were studied. Patient sociodemographic characteristics, symptom burden (measured via the Edmonton Symptom Assessment Scale, ESAS), and incidents of hospitalization, nursing home placement, and death were collected via medical chart review. Multivariate Cox proportional hazards models were used to analyze the effect of high symptom burden on time to first hospitalization, nursing home placement, and death. RESULTS 43% of the study sample had severe symptom burden (i.e. ESAS score ≥6 on at least one symptom). Patients with severe symptom burden were younger (82.0 vs 85.5 yrs, p<0.01), had more comorbid conditions (3.2 vs 2.5 Charlson score, p<0.01), higher prevalence of depression (43.4% vs 12.0%, p<0.01), lower prevalence of dementia (34.3% vs 60.6%, p<0.01), and utilized fewer hours of home health services (86.2 vs 110.4 hrs/wk, p<0.01). Severe symptom burden was associated with a shorter time to first hospitalization (hazards ratio=1.51, 95% CI 1.06–2.15) in adjusted models, but had no association with time to nursing home placement or death. CONCLUSION The homebound with severe symptom burden represent a unique patient cohort who are at increased risk of hospitalization. Tailored symptom management via home-based primary and palliative care programs may prevent unnecessary healthcare utilization in this population.

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Section: Discussionmentioning

confidence: 99%

Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound

Yang

Ornstein

Reckrey

2016

Journal of Pain and Symptom Management

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“…The lack of communication with the outside world eventually result in lying on bed or dementia, seriously impairing the elderly people's physical and mental health and life quality, and also placing huge pressure on their families, society, and social medical treatment. [3,4] Therefore, the concern on elderly homebound is essentially important in maintaining and improving the quality of life of elderly people, and also alleviating the burden on family and society, as well as preventing lying on bed and dementia.…”

Section: Introductionmentioning

confidence: 99%

Occurrence of and factors influencing elderly homebound in Chinese urban community

et al. 2017

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Studies on the occurrence of homebound and the factors influencing it are available. However, the study of community homebound in China is still in its preliminary stage. No previous studies about this issue are available. This study aims to assess the occurrence of and factors influencing homebound elderly in Chinese communities and to provide a basis for effective intervention and prevention of homebound elderly people.One sample community from three provinces was randomly selected. Investigations were performed on the selected communities and 2180 elderly people were chosen as the research subjects. Unified survey scales were used. Home visit and face-to-face interviews were performed to ensure that no single qualified survey respondent was missed.The rate of morbidity in homebound elderly Chinese community was found to be 15.49% and it gradually increased with age, and also with a lower education or poorer Activities of Daily Living (ADL). Single factor analysis showed that general situation, living habits, physical condition, mental condition, society, social support, and other factors affected the occurrence of community homebound elderly. Women were more likely to be homebound than men (P < .05). Having a spouse or high income reduced the rate of morbidity in the homebound elderly (P < .05). Multifactor regression analysis revealed that poor ADL, depression, hearing impairment, being old, no exercise, and low social support are the main influencing factors.Appropriate measures should be taken based on the specific influencing factor to prevent the occurrence of homebound.

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“…Many of these programs had NPs either as the primary provider or part of a multidisciplinary team. These programs demonstrated improved health outcomes, decreased emergency room visits, and lowered use of long‐term facilities (Stall et al., ). This evidence provides a strong basis for the establishment or expansion of these programs.…”

Section: Discussionmentioning

confidence: 99%

Obstacles to preventive care for individuals with disability

Marrocco

Krouse

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose Individuals with disabilities have been identified as a population with a significantly lower usage of preventive services. Nurse practitioners (NPs) provide a key access point in the healthcare delivery system for preventive services for vulnerable populations such as those with disabilities. It is essential to understand existing barriers that prohibit access to effective preventive care for this vulnerable population. Methods Systematic search and review of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PubMed, Google Scholar, and government reports and World Health Organizations reports. Twenty‐six articles were included in the review. Conclusions This literature review confirmed previous notions that people with disabilities are receiving much fewer preventive services than the general population. The studies reviewed identified four major barriers that contributed to the lack of preventive care. These barriers included physical environment and system, transportation, provider knowledge and attitude, and financial. Recognition of the obstacles that this subpopulation faces in accessing preventive care services is the first step to effectively remedying this problem. Implications for practice Preventive services have been identified as one of the cornerstones to improving health and quality of life. By understanding the circumstances that restrict those with disabilities from accessing preventive services, NPs can provide meaningful and effective solutions.

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Systematic Review of Outcomes from Home‐Based Primary Care Programs for Homebound Older Adults

Abstract: Specifically designed home-based primary care programs may substantially affect individual, caregiver and systems outcomes. Adherence to the core program components identified in this review could guide the development and spread of these programs.

Cited by 172 publications

References 39 publications

Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound

Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound

Occurrence of and factors influencing elderly homebound in Chinese urban community

Obstacles to preventive care for individuals with disability

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