The impact of co-ordinated community-based care for older people

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With an ageing population, there are more and more older adults who require health and social care resources. In England, these are supported by Community Mental Health Teams for older people (Wilberforce et al., 2013; 2015). One way to help these older adults in a less costly manner is care co-ordination.

Care co-ordination is meant to help people access the services they need and consists of four main elements (Challis et al., 2002):

  1. Face-to-face assessment of physical, psychological and social functioning;
  2. Identification of service needs;
  3. Access to services;
  4. Ongoing monitoring of needs.

In fact, care co-ordination is mostly found effective with many positive outcomes, such as reduced mortality, improved well-being, and delayed nursing home admission, which means that older adults can live more independently at home for longer. In return, this can reduce the amount of informal caring work undertaken by family and friends. However, some studies, including randomised controlled trials, have found care co-ordination to be as effective as mere information provision and referral to suitable services.

In this blog, I look at a recent study by Scharlach and colleagues (2015) from the School of Social Welfare at the University of California, Berkeley. These researchers wanted to know whether a co-ordinated community-based care service, called ‘ElderHelp Concierge Club’, is an effective way of support vulnerable older adults in the community.

Volunteers at the ElderHelp Concierge Club provide these seven different types of support:

  • Driving
  • Grocery shopping
  • Housekeeping
  • Home maintenance and repair
  • Financial advocacy
  • Friendly visiting
  • Pet care
The researchers investigated the impact of an older people's co-ordinated community-based service

The researchers investigated the impact of an older people’s co-ordinated community-based service

Method

The authors performed a retrospective study with 96 members of the club who had received services. For this purpose, the authors conducted telephone interviews and asked the members whether they had received the seven services on offer and how these services had affected their day-to-day life.

The authors also performed a prospective study with 21 members. For this study, members were asked to complete measures on physical well-being, activities of daily living, falls, mobility, psychological well-being, home safety and health service use both at the beginning of the club membership and after six months.

Findings

In the retrospective study, the authors showed that being a member of the club is helpful to one’s day-to-day life.

The most frequently used service was driving, followed by help to go shopping. The service used the least was pet care. People having received those service reported between 60% (social interaction) and 100% (e.g. home safety) satisfaction and improvements in these areas.

In the prospective study, people reported significantly fewer falls, but there was no effect on well-being or activities of daily living. Also, people reported to be more likely to have their medical needs met, and to leave the house.

Members of the club offering support with day to day things like driving and shopping reported significantly fewer falls.

Members of the club receiving support with day to day things like driving and shopping reported significantly fewer falls.

Conclusion

The authors conclude that

This study provides preliminary evidence that an integrated multilevel care co-ordination approach may be an effective and efficient model for serving vulnerable community-based elders, especially low and moderate-income elders who otherwise could not afford the cost of care.

Strengths and limitations

This study has a couple of minor limitations. Firstly, as mentioned by the authors, the retrospective study may be biased as it is based on self reports. Considering the ageing population accessing those services, some of which may have dementia and may have memory problems, the reports of improvements may be overestimated. Secondly, the prospective sample is relatively small, and a larger sample may have yielded further insights.

Summing up

Overall, this study shows the benefits of a simple support service which helps older adults accessing services through driving support or going to the local supermarket. It is these basic things that can make a huge difference to the life of an older person, and is probably something we don’t think about whilst we are still young and able to do all these things easily!

The study benefits from having two components, and not solely relying on retrospective self-reports. However, further research is needed. Although the study indicates positive impacts, some effects may not have been powerful enough in a small sample of 21 participants. In conclusion though, care co-ordination for vulnerable older adults appears to be an effective support model, as previous research has also suggested.

Although we are not part of a formal care co-ordination system, maybe we should all try and do one small thing for an older neighbour, and if it’s just a friendly visit or a lift to the shops every once in a while?

Given evidence on the benefits of support with simple daily tasks, maybe we should all try to do one thing for an older neighbour now and then?

Given evidence on the benefits of support with simple daily tasks, maybe we should all try to do one thing for an older neighbour now and then?

Link

Scharlach, A.E., Graham, C.L., & Berridge, C. (2015). An Integrated Model of Co-ordinated Community-Based Care. The Gerontologist, 55 (4), 677-687. [Abstract]

References

Challis DJ, Chesterman R, Luckett R, Stewart KJ, & Chessum R. (2002). Care management in social and primary health care: The Gateshead Community Care Scheme. Aldershot: Ashgate

Wilberforce, M., Tucker, S., Abendstern, M., Brand, C., Giebel, C.M., & Challis, D. (2013). Membership and management: structures of inter-professional working in community mental health teams for older people in England. International Psychogeriatrics, 25 (9), 1485-1492. [Abstract]

Wilberforce, M., Tucker, S., Brand, C., Abendstern, M., Jasper, R., Stewart, K., & Challis, D. (2015). Community mental health teams for older people: variations in case mix and service receipt (II). International Journal of Geriatric Psychiatry, 30 (6), 605-613. [Abstract]

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Clarissa Giebel

Clarissa is currently a Research Fellow at the University of Liverpool. Her research focuses on enabling people with dementia staying at home for as long as possible, whilst addressing potential health inequalities in accessing the right care. She is currently leading the first Covid-19 dementia study in the UK, exploring the effects of social service closures on the lives of people with dementia and unpaid carers. In her role as postdoctoral research associate at the NIHR ARC NWC, Clarissa is the Principal Investigator on a number of dementia and health inequalities projects. This includes a European Alzheimer's Society funded project into health inequalities in dementia care access in England and the Netherlands, also collecting Young Onset dementia specific data in Australia. Further funded international collaborations in dementia care include Colombia and Chile. She is also involved in the North West Coast Household Health Survey, looking at health inequalities in health service usage across the population. In addition, Clarissa is leading a care home collaboration, where she works jointly with colleagues from the Netherlands on implementing changes to a local Liverpool-based care home and developing a UK Dementia Village. Additional collaborations and projects include working with the Brain Charity evaluating social support groups for people with dementia, and with the Liverpool House of Memories to look into evaluating their intervention for family carers of people living with dementia and care professionals, and trying to roll the intervention out to other neighbourhoods.

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