Matthew Parsons

Does a Functional Activity Programme Improve Function, Quality of Life, and Falls for Residents in Long Term Care? Cluster Randomised Controlled Trial

Objective To assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care. Design Cluster randomised controlled trial with one year follow-up. Setting 41 low level dependency residential care homes in New Zealand. Participants 682 people aged 65 years or over. Interventions 330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants; 352 residents received social visits. Main outcome measures Function (late life function and disability instruments, elderly mobility scale, FICSIT-4 balance test, timed up and go test), quality of life (life satisfaction index, EuroQol), and falls (time to fall over 12 months). Secondary outcomes were depressive symptoms and hospital admissions. Results 473 (70%) participants completed the trial. The programme had no impact overall. However, in contrast to residents with impaired cognition (no differences between intervention and control group), those with normal cognition in the intervention group may have maintained overall function (late life function and disability instrument total function, P=0.024) and lower limb function (late life function and disability instrument basic lower extremity, P=0.015). In residents with cognitive impairment, the likelihood of depression increased in the intervention group. No other outcomes differed between groups. Conclusion A programme of functional rehabilitation had minimal impact for elderly people in residential care with normal cognition but was not beneficial for those with poor cognition. Trial registration Australian Clinical Trials Register ACTRN12605000667617.

Assessing the impact of a restorative home care service in New Zealand: a cluster randomised controlled trial.

Due to the ageing population, there is an increased demand for home care services. Restorative care is one approach to improving home care services, although there is little evidence to support its use in the community setting. The objective of this trial was to evaluate the impact of a restorative home care service for community-dwelling older people. The study was a cluster randomised controlled trial undertaken at a home care agency in New Zealand. The study period was from December 2005 to May 2007. Older people were interviewed face-to-face at baseline, four and 7 months. A total of 186 older people who received assistance from a home care agency participated in the study, 93 received restorative home care and 93 older people received usual home care. The primary outcome measure was change in health-related quality of life (measured by the Short Form 36 [SF36] Health Survey). Secondary outcomes were the physical, mental, and social well-being of older people (Nottingham Extended Activities of Daily Living, Timed Up and Go, Mastery scale, Duke Social Support Index). Findings revealed that compared with usual care, the intervention demonstrated a statistically significant benefit in health-related quality of life (SF36) at 7 months for older people (mean difference 3.8, 95% CI -0.0 to 7.7, P = 0.05). There were no changes in other scale measurements for older people in either group over time. There was a statistically significant difference in the number of older people in the intervention group identified for reduced hours or discharge (29%) compared with the control group (0%) (P < 0.001). In conclusion, a restorative home care service may be of benefit to older people, and improves home care service efficacy.

The providers’ profile of the disability support workforce in New Zealand

To understand one of the predominant groups supporting people with disabilities and illness, this study examined the profile of New Zealand paid caregivers, including their training needs. Paid caregivers, also known as healthcare assistants, caregivers and home health aides, work across several long-term care settings, such as residential homes, continuing-care hospitals and also private homes. Their roles include assisting with personal care and household management. New Zealand, similar to other countries, is facing a health workforce shortage. A three-phased design was used: phase I, a survey of all home-based and residential care providers (N = 942, response rate = 45%); phase II, a targeted survey of training needs (n = 107, response = 100%); phase III, four focus groups and 14 interviews with 36 providers, exploring themes arising from phases I and II. Findings on 17,910 paid caregivers revealed a workforce predominantly female (94%), aged between 40 and 50, with 6% over the age of 60. Mean hourly pay NZ

A restorative home care intervention in New Zealand: perceptions of paid caregivers.

10.90 (minimum wage NZ

Promoting Independence in Residential Care: Successful Recruitment for a Randomized Controlled Trial

10.00 approx. UK3.00 at time of study) and 24 hours per week. The national paid caregiver turnover was 29% residential care and 39% community. Most providers recognised the importance of training, but felt their paid caregivers were not adequately trained. Training was poorly attended; reasons cited were funding, family, secondary employment, staff turnover, low pay and few incentives. The paid caregiver profile described reflects trends also observed in other countries. There is a clear policy direction in New Zealand and other countries to support people with a disability at home, and yet the workforce which is facilitating this vision is itself highly vulnerable. Paid caregivers have minimum pay, are female, work part-time and although it is recognised that training is important for them, they do not attend, so consequently remain untrained.

The Assessment of Services Promoting Independence and Recovery in Elders Trial (ASPIRE): a pre-planned meta-analysis of three independent randomised controlled trial evaluations of ageing in place initiatives in New Zealand

Paid caregivers possess an essential role in home care services. However, recruitment and retention issues are extensive within this workforce, largely in relation to poor working conditions. This article primarily focuses on the qualitative data extracted from a large randomised controlled trial in New Zealand and is supported by some quantitative findings. The aim was to explore paid caregiver perceptions of a restorative home care intervention in comparison with usual home care. The purpose of the qualitative exploration was to gather rich descriptive data that highlight differences between the two services with an emphasis on the workforce viewpoint. Four focus groups were undertaken with paid caregivers, two at baseline (4 and 5 participants in the control and intervention groups, respectively) and two at 14 months (eight participants in each focus group). Focus group data were collected in December 2005 and February 2007. A general inductive approach was used to analyse focus group transcripts. Two themes emerged from both the control and intervention focus groups: relationship with older people and issues with home care service delivery. A further two themes were pertinent to the intervention group: job satisfaction and preintervention. Findings revealed the intervention had a substantial positive impact on paid caregiver job satisfaction in comparison with usual care. This appeared to be due to improved training, increased support and supervision, and more flexibility. The intervention resulted in positive changes from the paid caregiver perspective and substantially reduced turnover in comparison with usual home care. However, both groups identified the need for further improvements to their working conditions. In addition, the need to regulate this vulnerable workforce is discussed.

Assessment without action; a randomised evaluation of the interRAI home care compared to a national assessment tool on identification of needs and service provision for older people in New Zealand

OBJECTIVES To describe the recruitment strategy and association between facility and staff characteristics and success of resident recruitment for the Promoting Independence in Residential Care (PIRC) trial. DESIGN Cross-sectional study of staff and facility characteristics and recruitment rates within facilities with calculation of cluster effects of multiple measures. SETTING AND PARTICIPANTS Staff of low-level dependency residential care facilities and residents able to engage in a physical activity program in 2 cities in New Zealand. MEASURES A global impression of staff willingness to facilitate research was gauged by research nurses, facility characteristics were measured by staff interview. Relevant outcomes were measured by resident interview and included the following: (1) Function: Late Life FDI scale, timed-up-and-go, FICSIT balance scale and the Elderly Mobility Scale; (2) Quality of Life: EuroQol quality of life scale, Life Satisfaction Index; and (3) falls were assessed by audit of the medical record. Correlation between recruitment rates, facility characteristics and global impression of staff willingness to participate were investigated. Design effects were calculated on outcomes. RESULTS Forty-one (85%) facilities and 682 (83%) residents participated, median age was 85 years (range 65-101), and 74% were women. Participants had complex health problems. Recruitment rates were associated (but did not increase linearly) with the perceived willingness of staff, and were not associated with facility size. Design effects from the cluster recruitment differed according to outcome. CONCLUSIONS The recruitment strategy was successful in recruiting a large sample of people with complex comorbidities and high levels of functional disability despite perceptions of staff reluctance. Staff willingness was related to recruitment success.

‘Doing with …’ rather than ‘doing for …’ older adults: rationale and content of the ‘Stay Active at Home’ programme:

INTRODUCTION intermediate care has been developed to support older people to remain living in their own homes, combining a higher level of support with a rehabilitation focus. Evidence around their effectiveness remains mixed and there is ambiguity around the components. AIMS to establish the impact of intermediate care on institutional free survival in frail older people referred for needs assessment in New Zealand (NZ). METHODS pre-planned meta-analysis of three randomised controlled trials with follow-up at 3, 6, 12, 18 and 24 months. A total of 567 older people at risk of permanent institutionalisation as well as their primary informal carer (n = 234) were randomised to either intermediate or usual care. Interventions had common key features of care management, though varied in the use of ongoing care provision. RESULTS the adjusted hazard ratio for the combined primary outcome of death or residential entry was 31% lower with a 95% confidence interval of (9%, 47%) for the intermediate care initiatives compared with usual care. CONCLUSION intermediate care utilising a care management approach reduces a frail older persons risk of mortality and permanent institutionalisation.

Leading change within health services

Comprehensive geriatric assessment (CGA) is considered the cornerstone of good practice, as it identifies need across multiple domains such as social, physical and psychological. The interRAI home care (interRAI-HC), probably the most well-researched and supported community-based CGA has been implemented globally, often at considerable expense. Policy-makers, managers and clinicians anticipate significant gains in health outcomes following such investment; however, the implementation of CGA is often undertaken in the absence of community service development. This study sought to compare the interRAI-HC with an existing CGA [the Support Needs Assessment (SNA)] in community-dwelling older people. A randomised controlled trial was undertaken from January 2006 to January 2007 comparing the interRAI-HC and the SNA in 316 people (65+) referred for assessment of needs with follow-up at 1 and 4 months. Outcomes included health-related quality of life, physical function, social support, cognitive status, mood and health service usage as well as identified need. The study found that significantly more support needs were identified using the interRAI-HC compared to the SNA. More social and carer support were recommended by SNA and more rehabilitation and preventive health screens were recommended by interRAI-HC. Despite these differences, the mean healthcare use was similar at 4 months, although interRAI-HC participants had more Emergency Department presentations and hospital admissions. No statistically significant differences between groups were reported in terms of outcomes. In conclusion, the interRAI-HC was found to identify more unmet support needs than the SNA though resulted in no favourable outcomes for the older person or their carer. The study highlights the need to invest attention around the service context to maximise outcomes based on identified needs.

Randomised trial of restorative home care for frail older people in New Zealand

Background: Owing to increasing age, accidents or periods of illness, home care services are provided to community-dwelling older adults. Traditionally, these services focus on doing things for older adults rather than with them; though from a rehabilitative perspective, it is important to assist older adults to attain and maintain their highest level of functioning. Consequently, a re-orientation of home care services is required away from treating disease and creating dependency towards focusing on capabilities and opportunities and maximising independence. To achieve this behavioural change in home care professionals, the ‘Stay Active at Home’ programme was developed. Aims and methods: The aim of this article is to give a detailed description of the rationale and content of the ‘Stay Active at Home’ programme by making use of the TIDieR (Template for Intervention Description and Replication) Checklist. Approach: ‘Stay Active at Home’ is a comprehensive training programme that aims to equip home care professionals (i.e. community nurses and domestic support workers) with the necessary knowledge, attitude, skills and social and organisational support to deliver day-to-day services at home from a more rehabilitative perspective. More specifically, home care professionals are expected to deliver goal-oriented, holistic and person-centred services focusing on supporting older adults to maintain, gain or restore their competences to engage in physical and daily activities so that they can manage their everyday life as independently as possible.