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Final report: reablement and older people
- Authors:
- MISHRA Vyvyan, BARRATT Jane
- Publishers:
- International Federation on Ageing, DaneAge
- Publication year:
- 2016
- Pagination:
- 36
- Place of publication:
- Toronto
This report considers the potential of the reablement model to maintain and improve the functional capacity of older people and the degree to which it may reduce the need for services, and even reduce the premature admission of older people to a range of institutional care. It summarises the discussion papers produced by four expert working groups at the International Federation on Ageing (IFA) Global Think Tank. Experts were medical specialists, scientists and researchers and worked in the fields of dementia, diabetes, frailty and assistive technology. The report summarises experts responses to five questions: What does a reablement model look like, including what supports are needed?; Why should a reablement approach be used by stakeholders (government, funders, individuals and caregivers)?; What are the gaps in knowledge and practice that need to be addressed for reablement to be considered a viable policy strategy?; What are the implementation challenges pertaining to each theme (dementia, diabetes and frailty); and What are the societal and individual implications of the reablement approach globally? The report highlights the perceived benefits and challenges in a reablement approach. It also presents recommendations for research and implementation. These include a need to assess the cost-effectiveness of reablement interventions and to develop an understanding of how best to establish services to identify, monitor and deliver appropriate services. (Edited publisher abstract)
Occupation-focused health promotion for well older people: a cost-effectiveness analysis
- Authors:
- ZINGMARK Magnus, et al
- Journal article citation:
- British Journal of Occupational Therapy, 79(3), 2016, pp.153-162.
- Publisher:
- Sage
Introduction: The aim of this study was to evaluate three occupational therapy interventions, focused on supporting continued engagement in occupation among older people, to determine which intervention was most cost effective, evaluated as the incremental cost/quality adjusted life year gained. Method: The study was based on an exploratory randomised controlled trial. Participants were 77–82 years, single living and without home help. One hundred and seventy seven persons were randomised to an individual intervention, an activity group, a discussion group or a no intervention control group. All interventions focused on supporting the participants to maintain or improve occupational engagement. Outcomes were evaluated at baseline, three and 12 months and included general health and costs (intervention, municipality and health care). Based on linear regression models, we evaluated how outcomes had changed at each follow-up for each intervention group in relation to the control group. Results: Both group interventions resulted in quality adjusted life years gained at three months. A sustained effect on quality adjusted life years gained and lower total costs indicated that the discussion group was the most cost-effective intervention. Conclusion: Short-term, occupation-focused occupational therapy intervention delivered in group formats for well older people resulted in quality-adjusted life years gained. A one-session discussion group was most cost effective. (Publisher abstract)
Admission avoidance hospital at home (review)
- Authors:
- SHEPPERD Sasha, et al
- Publishers:
- John Wiley and Sons, Cochrane Collaboration
- Publication year:
- 2016
- Pagination:
- 67
Aims: There continues to be more demand for acute hospital beds than there are beds. One way to reduce reliance on hospital beds is to provide people with acute health care at home, sometimes called ’hospital at home’. This systematic review of the literature examines the effect of providing hospital at home services to avoid hospital admission for adults. This is the third update of the original review. Results: A total of 16 studies were retrieved, of which six were identified for this update. Three studies recruited participants with chronic obstructive (lung) disease, two recruited participants recovering from a stroke, six recruited participants with a (sudden or short-term) medical condition who were mainly elderly, and the remaining studies recruited participants with a mix of conditions. The studies showed that when compared to in-hospital care, admission avoidance hospital at home services probably make little or no difference to patient health outcomes or to the likelihood of being taken to hospital, and may increase the chances of living at home at six months’ follow-up. Patients who receive care at home may be more satisfied than those who are in hospital, but it is not known how this type of health care affects the caregivers who support them. With respect to costs, it is uncertain if hospital at home services reduce or increase length of stay or cost to the health service; when the costs for caregivers are taken into account any difference in cost may disappear. Conclusion: Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of elderly patients requiring hospital admission. However, the evidence is limited by the small randomised controlled trials included in the review, which adds a degree of imprecision to the results for the main outcomes. (Edited publisher abstract)
Evaluation of Southwark and Lambeth integrated care programme: report
- Authors:
- WOLFE Charles, et al
- Publisher:
- King's College London
- Publication year:
- 2016
- Pagination:
- 117
- Place of publication:
- London
Detailed evaluation of the Southwark and Lambeth Integrated Care (SLIC) project, which was set up as a partnership of commissioners and providers across health and social care, along with local people, to improve the value of care in Southwark and Lambeth. Its main aims were to identify and address care needs at an early stage; provide join up care around people and across providers and provide care in the most appropriate setting. The programme focused on older people and long term conditions and aimed to reduce emergency hospital admission and care home utilisation. The evaluation assesses the value of the £10.6 million spent on the project, looks at what worked and what didn’t in improving value and the reasons for this. It also highlights lessons learnt from the programme. Methods included an analysis of quantitative data to examine expenditure, documentary analysis, interviews with stakeholders and focus groups. It also provides a synthesis of the published evidence on integrated care, including evaluations of the Southwark and Lambeth Integrated Care project to date, and literature on governance. Successful outcomes of the project identified included: good integrated working by partners across health and social care; reduced admission to care homes and no increase in the rate of emergency admissions to hospital; citizen engagement and co-production; and a reported shift in investment from acute care towards community and primary care. (Edited publisher abstract)
Cost-effectiveness of social work services in aging: an updated systematic review
- Authors:
- RIZZO Victoria M., ROWE Jeannine M.
- Journal article citation:
- Research on Social Work Practice, 26(6), 2016, pp.653-667.
- Publisher:
- Sage
Objectives: This study examines the impact of social work interventions in ageing on quality of life (QOL) and cost outcomes in four categories (health, mental health, geriatric evaluation and management, and caregiving). Methods: Systematic review methods are employed. Databases were searched for articles published in English between 2004 and 2012 that report outcomes of social work interventions for ageing individuals (age ≥ 50) and/or their caregivers/families. Of the 464 identified articles, 45 representing 42 studies met inclusion criteria. Results: Seventy-one percent of the studies report significant QOL outcomes. Twenty-one studies include cost outcomes, with 15 (71.4%) documenting significant cost savings. Twelve (80%) of the studies reporting significant cost outcomes examine social work interventions in health, including care coordination and end-of-life/palliative care. Conclusion: The findings suggest that social work interventions in ageing have a positive and significant impact on QOL and cost outcomes. Applications for social work practice and research are discussed. (Edited publisher abstract)
The cost-benefit to the NHS arising from preventative housing interventions
- Authors:
- GARRETT Helen, et al
- Publisher:
- IHS BRE Press
- Publication year:
- 2016
- Place of publication:
- Bracknell
This report consider the cost-effectiveness of preventative home interventions for people with long-term sickness or disability by reducing the need for NHS treatment and subsequent need for reactive home adaptations. The report uses a modelling approach to estimate the nature and quantity of hazards that exist in the homes of people who are most at risk of harm; estimates the reduction in cost to the NHS which would arise from undertaking home modifications to mitigate risk; estimates to what extent the costs of mitigation work can be offset by savings to the Disabled Facilities Grant (DFG) adaptations budget; and considers some additional costs to society of not undertaking home for the disabled and vulnerable people. It also provide further empirical evidence of the benefits of home interventions through case studies. The report illustrates that significant savings can be made by undertaking preventative home interventions where risks of harm are known to exist. It estimates that there is need for preventative work in around three million households who have a long-term sickness and disability, which would reduce the likelihood of NHS treatment and the need for a DFG adaptation required as a result of injury. (Edited publisher abstract)
The economic value of Dorset POPP services. A focus on two significant issues: malnutrition and fire safety
- Authors:
- HARFLETT Naomi, et al
- Publisher:
- National Development Team for Inclusion
- Publication year:
- 2016
- Pagination:
- 20
- Place of publication:
- Bath
An economic analysis of three schemes from Dorset Partnership for Older People Projects (POPP), focusing on their value and effectiveness in preventing malnutrition and preventing fire related injuries. Dorset POPP schemes use a community led preventative approach and aim to improve the quality of life of older people and to save money by preventing ineffective use of publicly funded services. The report uses published figures of the costs of malnutrition and the economic value of preventing fire injuries and applies the figure to contact monitoring and costs data from three of the Dorset POPP projects to provide an estimate of the potential economic value. The schemes are: the Wayfinder Programme, which provides signposting and support on services such as welfare benefits and pensions, retaining independent living, social activities, telecare and lunch clubs; the Community Initiatives Commissioning Fund (CICF), which funds initiatives identified by local people such as lunch clubs, social clubs, and neighbourcare schemes; and Safe And Independent Living (SAIL) multi-agency referral scheme, which provides a multi-agency referral approach to enabling access to signposting, support, and services. For all of the interventions included in the analysis, just a very small proportion (often less than one per cent) of the contacts or referrals made would be needed to prevent malnutrition or fire related injuries, in order to save money. (Edited publisher abstract)
The cost-effectiveness of grip on challenging behaviour: an economic evaluation of a care programme for managing challenging behaviour
- Authors:
- ZWIJSEN S.A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(6), 2016, pp.567-574.
- Publisher:
- Wiley
Objective The objective of the study was to evaluate the cost-effectiveness of implementing the Grip on Challenging Behaviour care programme (GRIP) on dementia special care units in comparison with usual care. Methods: A stepped wedge design was used. Challenging behaviour and quality of life were measured using the Cohen Mansfield Agitation Inventory (CMAI) and the QUALIDEM. Quality-adjusted life years (QALYs) were calculated using the EuroQol-5D. Psychoactive medication use (range 0–5 per measurement) and sick leave were registered. Costs included medication, time spent on challenging behaviour and education. Costs and effects were analysed using linear multilevel regression. Incremental cost-effectiveness ratios were calculated. Statistical uncertainty was estimated using bootstrapping. Results: Seventeen dementia special care units participated. GRIP led to improvement on the QUALIDEM subscale social relations (1.6; 95% CI 0.18 to 3.4) and on the use of psychoactive medication (−0.73; 95% CI −1.1 to −0.46) and to a decrease in QALYs (−0.02; 95% CI −0.06 to −0.003). No significant effects on CMAI, sick leave and other QUALIDEM subscales were found. The intervention was not cost-effective in comparison with usual care with regard to CMAI score, QALYs and sick leave. The willingness to pay should be 320€/point improvement on the QUALIDEM subscale social relations and 370€/psychoactive medication less to reach a 0.95 probability of cost-effectiveness. Conclusion: It depends on how much society is willing to pay whether GRIP can be considered cost-effective. Because the appropriateness of the current methods for analysing cost-effectiveness in this specific population is uncertain, the positive effects on behaviour, medication and job satisfactions should also be taken in account in the decision making (Publisher abstract)
Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial
- Authors:
- D' AMICO Francesco, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(6), 2016, p.656–665.
- Publisher:
- Wiley
Objective: Although available evidence is modest, exercise could be beneficial in reducing behavioural and psychological symptoms of dementia. The authors aim to evaluate the cost-effectiveness of a dyadic exercise regimen for individuals with dementia and their main carer as therapy for behavioural and psychological symptoms of dementia. Methods: Cost-effectiveness analysis within a two-arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored, for 20–30 min at least five times per week). The study randomised 131 community-dwelling individuals with dementia and clinically significant behavioural and psychological symptoms with a carer willing and able to participate in the exercise regimen; 52 dyads provided sufficient cost data for analyses. Results: Mean intervention cost was £284 per dyad. For the subsample of 52 dyads, the intervention group had significantly higher mean cost from a societal perspective (mean difference £2728.60, p = 0.05), but costs were not significantly different from a health and social care perspective. The exercise intervention was more cost-effective than treatment as usual from both societal and health and social care perspectives for the measure of behavioural and psychological symptoms (Neuropsychiatric Inventory). It does not appear cost-effective in terms of cost per quality-adjusted life year gain. Conclusions: The exercise intervention has the potential to be seen as cost-effective when considering behavioural and psychological symptoms but did not appear cost-effective when considering quality-adjusted life year gains. (Edited publisher abstract)
Comparing the cost-effectiveness and clinical effectiveness of a new community in-reach rehabilitation service with the cost-effectiveness and clinical effectiveness of an established hospital-based rehabilitation service for older people...
- Authors:
- SAHOTA Opinder, et al
- Journal article citation:
- Health and Social Care Delivery Research, 4(7), 2016, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
Background: Older people represent a large proportion of patients admitted to hospital as a medical emergency. Two rehabilitation services are currently provided: one is the standard service (traditional hospital-based rehabilitation, THB-Rehab), whereby patients are managed by the therapists employed by the hospital, and the other is a new service (Community In-Reach Rehabilitation And Care Transition, CIRACT) delivered by the community rehabilitation team, who work directly on the hospital ward and therefore are able to ensure a smoother and quicker discharge home. The aim of this study was to compare the differences and costs between these two services. Methods: The main outcomes were number of days in hospital; readmission back into hospital, physical ability and health-related quality of life at day 91; and detailed costs of the service and any cost savings made. Face-to-face interviews were also undertaken with staff and patients to gain a wider understanding of the two different services and their individual experiences of them. Results: There was no significant difference in length of stay or in any of the other outcomes between the CIRACT service and the THB-Rehab service. The cost of delivering the CIRACT service and the THB-Rehab service, as determined by the detailed microcosting analysis, was £302 and £303 per patient respectively. Using more detailed costing including health and social care costs, the cost of delivering the CIRACT service and the THB-Rehab service was £3744 and £3603 per patient respectively. Although the CIRACT service was highly regarded by those most involved with it, it struggled to fit in with services already provided in the community. Conclusion: The CIRACT service does not reduce hospital length of stay or short-term readmission rates although the users liked the service. The CIRACT service may be cost-effective compared with the standard ward rehabilitation service, although these results have to be interpreted with caution. (Edited publisher abstract)