PATON Fiona, WILSON Paul, WRIGHT Kath
A synthesis of evidence assessing the predictive ability of tools used to identify frail elderly and people living with multiple long-term chronic health conditions who are at risk of future unplanned hospital admissions. There are now a large number of models available that can be used to predict the risk of unplanned hospital admissions and this study aims to provide a summary of their comparative performance. Overall, the models identified in this review show reasonable concordance in terms of their predictive performance (based on c-statistics). Models reporting other performance indications showed that at different thresholds, as sensitivity increased, specificity would decrease. As the algorithms become more complex or incorporate longer term horizons specificity increased but the ability of the models to identify future high cost individuals reduced. It should also be noted that whilst the reported c-statistics are broadly similar, the underlying populations, data sources and coding may differ.
DOUGHTY Kevin, MULVIHILL Patrick
Purpose: The purpose of this paper is to consider the importance of digital healthcare through telecare and portable assistive devices in supporting the reengineering of healthcare to deal with the needs of an older and more vulnerable population wishing to remain in their own homes.
Design/methodology/approach: It supports the importance of the assessment process to identify hazards associated with independent living, and the possible consequences of accidents. By measuring and prioritising the risks, appropriate management strategies may be introduced to provide a safer home environment.
Findings: A process for assessing and managing these risks has been developed. This can be applied to a wide range of different cases and yields solutions that can support independence.
Research limitations/implications: The developed digital reablement process can be used to provide vulnerable people with a robust form of risk management.
Practical implications: If telecare services follow the process described in this paper then they will improve the outcomes for their users.
Originality/value: The process described in this paper is the first attempt to produce a robust assessment process for introducing telecare services in a reablement context.
Older people represent the main in-patient group, at any one time occupying more than two-thirds of acute hospital in-patient beds. Providers and commissioners need to put in place cost-effective, community based services, which can both prevent the need for hospital admission and safely reduce length of stay for older people. A hospital admission can occur when an older person has reached breaking point because of a combination of problems that have been building up before admission: social circumstances (such as living alone or having caring responsibilities) or general frailty. The aim of this publication is to disseminate examples of positive practice in avoiding hospital admission, supporting safe discharge and preventing readmission for older people. This publication highlights 5 examples of local Age UK services, charting the ‘pathway’ of prevention from identifying older people in the local community who may be at risk, to supporting people who are in A&E, and ensuring that discharge from in-patient care is safe and well co-ordinated.
MAYO-WILSON Evan, et al
Background: Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalisation and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services.
Methods and Findings: Data Sources: Ten databases including CENTRAL and Medline searched through December 2012. Study Selection: Randomised controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge. Two authors independently extracted data. Outcomes were pooled using random effects. Main Outcomes and Measures used were mortality, institutionalisation, hospitalisation, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.
Results: Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programmes may have small relative effects. There was moderate quality evidence of no overall effect on the number of people institutionalised. There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect, but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life and physical functioning respectively, but these may not be clinically important.
Conclusions: Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programmes that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, the authors cannot exclude the possibility that some programmes may be effective.