A randomized controlled trial of the effect of an intensive 1-year care management program on measures of health status in independent, community-living old elderly: the Eldercare project

Abstract

Background: Primary care practitioners are familiar with the frail elderly and commonly have to deal with their multi-morbidity and their functional decline, both physically and mentally. However, there are well elderly with high quality of life and very few co-morbidities who seldom seek medical care.

Objective: To determine if a nurse-based program of home-delivered care, linked directly with the primary care practitioner or primary care team, would improve quality of life, symptoms, satisfaction with care and utilization of community and medical services, in independent community living old elderly.

Design: Randomized controlled trial.

Setting: St. John's, Newfoundland, Canada.

Participants: Two hundred and thirty-six independent, community-dwelling, cognitively functioning, people aged 80 years and older.

Intervention: A nurse-based program of care, carried out in the patients home, that involved a detailed assessment of needs, the development of a plan to meet the needs, and up to eight visits to the patients home during a 1-year period to facilitate the meeting of those needs.

Control group: Usual care

Main outcome measurements: Quality of Life measured using the SF-36 and the CASP-19 scales; symptomology using the Comorbidity Symptom Scale; patient satisfaction using the PSQ-18; and assessment of health care services (community services, emergency room visits, hospitalizations, use of diagnostic services and family doctor visits) through patient recall, family physician chart review and assessment of hospitalization records.

Results: There were no statistical or meaningful differences between the intervention and control groups in any of the outcomes measured.

Conclusion: The intensive, home-delivered, program of care for the well old elderly did not have an impact on the outcomes measured.

Keywords: Aging; Geriatrics; Health promotion; Nursing; Primary care; Quality of life..