Oud word je niet alleen. Een enquête over eenzaamheid en sociaal isolement bij ouderen in België

nrpages: 164status: publishe

Fall determinants and home modifications by occupational therapists to prevent falls

BACKGROUND: Approximately one third of older people over 65 years fall each year. Home modifications may decrease occurrence of falls. PURPOSE: This study aims to determine the risk factors of falls for frail older persons and to evaluate the impact of home modifications by an occupational therapist on the occurrence of falls. METHOD: We conducted a longitudinal study using a quasiexperimental design to examine occurrence of falls. All participants 65 years of age and older and were assessed at baseline and 6 months after the intervention. Bivariate analysis and logistic regression models were used to study the risk factors of falls and the effect of home modifications on the incidence of falls. FINDINGS: The main predictors of falls were vision problems, distress of informal caregiver, and insufficient informal support. Home modifications provided by an occupational therapist showed a significant reduction of falls. IMPLICATIONS: Informal caregivers and their health status had an impact on the fall risk of frail older persons. Home modifications by an occupational therapist reduced the fall risk of frail older persons at 6-months follow-up.status: publishe

Case management projects enabling frail older people to stay in their own home -building quality indicators for the evaluation of Protocol 3 projects

Aggregated results of systematic reviews show that case management interventions have mixed or no impact on frail older persons outcomes, excepted in terms of beneficiaries’ satisfaction of overall care and relieving burden of informal caregivers (AHRQ, 2013). Heterogeneity of case management interventions seems to be responsible for these inconclusive results. 63 innovative projects are currently financed under « Protocol3 », and are evaluated. Out of these 63, 21 are case management (CM) projects. Primary outcome is the risk of frail older person’s institutionnalization; secundary outcomes include functional status, perceived health, quality of life and burden of the informal caregiver. The purpose of this research was to investigate whether and under which conditions the 21 case management projects – provided alone or in combination with other intervention(s) of Protocol 3 - were effective to decrease the risk of institutionalization of frail elderly living at home, and why. Other outcomes (i.e. quality of life, functional status and perceived burden of their main informal caregiver) are described elsewhere. Following a mixed methods design, the impact of the projects was investigated through an implementation and effectiveness analysis. To guide data collection and analyses, projects were viewed as complex adaptative systems (Plsek & Greenhalgh, 2001). A primary in-depth analysis of five projects, using a case study methodology, allowed a precise description of the components, interaction patterns and level of implementation of these projects. Secondly, based on Wagner’s Chronic Care Model (1996) and subsequent ACIC quality indicators (Bonomi & al., 2002) and first results of the implementation and effectiveness analysis, quality indicators were constructed, to further identify the determinants and mechanisms of the projects’ impact on frail older persons’ outcomes, as viewed by the professionals of the projects (Greenhalgh et al., 2004). Case study methodology allowed the identification of project components (structural or process-related) who could have an impact on frail older persons delay of instutionnalization. 25 relevance criteria derived from these empirical results, along with elements from Wagner’s Chronic Care model (1996) were grouped into eight domains. Appropriateness of the workforce Tailored service design and organisation Self-management and support Community linkages Appropriateness of financial incentives Processes in support of quality of care Knowledge management and decision support Clinical information tools 20 CM projects were assessed following these quality indicators; results are provided per subgroup of CM projects. The higher the score, the more appropriate the domain was reported

A comprehensive grid to evaluate case management’s effectiveness for community-dwelling frail older people: results from a multiple, embedded case study

Background. Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. Methods. The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner’s Chronic Care Model and the theory of complexity. Results. The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more “socially-oriented” type towards a more “clinically-oriented” type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. Conclusion. The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs

A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study

BACKGROUND: Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. METHODS: The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. RESULTS: The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. CONCLUSION: The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.status: publishe

Erratum to: A comprehensive grid to evaluate case management’s expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study

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