Age and Ageing Advance Access originally published online on May 19, 2004
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Age and Ageing 2004; 33: 384-390
Age and Ageing Vol. 33 No. 4 © British Geriatrics Society 2004; all rights reserved
Research Paper |
A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people
1 Division of Rehabilitation and Ageing, 2 School of Nursing, 3 School of Sociology and Social Policy, University of Nottingham, Nottingham NG7 2UH, UK
4 Trent Institute for Health Services Research, Medical School, University Hospital, Nottingham NG7 2UH, UK
5 Nottingham City Primary Care Trust, Gregory Boulevard, Nottingham NG7 5HY, UK
6 Trent Institute for Health Services Research, University of Nottingham, Nottingham NG7 2UH, UK
Address correspondence to: J. R. F. Gladman, Division of Rehabilitation and Ageing, B Floor Medical School, University of Nottingham, Nottingham NG7 2UH, UK. Fax: (+44) 115 942 3618. Email: john.gladman{at}nottingham.ac.uk
Abstract
Objectives: to evaluate the effect of a care home rehabilitation service on institutionalisation, health outcomes and service use.
Design: randomised controlled trial, stratified by Barthel ADL index, social service sector and whether living alone. The intervention was a rehabilitation service based in Social Services old people's homes in Nottingham, UK. The control group received usual health and social care.
Participants: 165 elderly and disabled hospitalised patients who wished to go home but were at high risk of institutionalisation (81 intervention, 84 control).
Main outcome measures: institutionalisation rates, Barthel ADL index, Nottingham Extended ADL score, General Health Questionnaire (12 item version) at 3 and 12 months, Health and Social Service resource use.
Results: the number of participants institutionalised was similar at 3 months (relative risk 1.04, 95% confidence intervals 0.65–1.65) and 12 months (relative risk 1.23, 95% confidence intervals 0.75–2.02). Barthel ADL Index, Nottingham Extended ADL score and General Health Questionnaire scores were similar at 3 and 12 months. The intervention group spent significantly fewer days in hospital over 3 and 12 months (mean reduction 12.1 and 27.6 days respectively, P < 0.01), but spent a mean of 36 days in a care home rehabilitation service facility.
Conclusions: this service did not reduce institutionalisation, but diverted patients from the hospital to social services sector without major effects on activity levels or well-being.
Keywords: health services for the aged, rehabilitation, care homes, randomised controlled trial, elderly
Received January 27, 2003; Revision received February 5, 2004. accepted in revised form February 5, 2004.
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