Many older adults prefer to age in place even in the face of frailty or other serious health concerns. A forthcoming article reports on a meta-analysis of three independent randomized controlled trials (RCTs) in New Zealand that tested the effectiveness of intensive, in-home care management for frail older adults wishing to age in place.
The three studies were conducted in three different regions of New Zealand, involving a total of 567 older adult participants who were at risk of institutionalization. The three different sites involved experimental care interventions that differed from one another somewhat, though all involved in-home care with a focus on coordinating and managing the participants’ health needs. These were compared to standard in-home care, which is less intensive and less focused on coordination of health care. At two of the sites, each individual was randomly assigned to either the intervention or the standard group; at the third, participants were recruited through their general practitioners’ offices, so clusters of each office’s patients were randomly assigned to either condition. The cost of the interventions was higher than standard care, though less than that of a comparable full-time residential care site.
The primary outcome was whether or not, at various follow-ups, the participants were still living in their homes. The study also included secondary outcomes such as changes in caregiver burden, depression, chronic disease symptoms, and difficulties with instrumental activities of daily living (IADLs) or tasks such as cooking and housework that are necessary to live independently.
At each site, participants in the intervention group were more likely to remain independent than those in the standard, control group. Overall, when statistically accounting for various related factors such as level of need and living situation, there was an over 31% difference in likelihood of being able to age in place between the interventions and standard care. For the secondary outcomes, only IADLs appeared different between the two groups, though the difference, while statistically significant, was not large or clinically significant. There was also no difference in caregiver burden between the intervention and control groups. Well-coordinated home-based care management seems able to allow older adults who are at risk for loss of independence to remain in their homes, without increasing burden to their families or other caregivers.
Parsons M, Senior HEJ, et al. 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. Age and Ageing (2012). E-pub ahead of print: doi:10.1093/ageing/afs113.