Meeting the Home-care Needs of Disabled Older Persons Living in the Community: Does Integrated Services Delivery Make a Difference?

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2011 Oct 28

PMID 22029878

Citations 22

Authors

Nicole Dubuc

Marie-France Dubois

Michel Raiche

Ndeye Rokhaya Gueye

Rejean Hebert

Affiliations

Soon will be listed here.

Abstract

Background: The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD) network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community.

Methods: Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF). We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study.

Results: On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08) of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r2 = 0.25; p < 0.001). At the end of the study, 35% (95% CI: 31% to 40%) of elders with needs living in the ISD area had at least one unmet need, compared to 67% (95% CI: 62% to 71%) in the other area. In general, unmet needs were highest for bathing, grooming, urinary incontinence, walking outside, seeing, hearing, preparing meals, and taking medications.

Conclusions: In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.

Citing Articles

Understanding Care Needs of Older Adults with Disabilities: A Scoping Review.

Zhou W, Gao Y, Wang Y, Liu J, Wang Q, Zhou L J Multidiscip Healthc. 2024; 17:2331-2350.

PMID: 38770173 PMC: 11104368. DOI: 10.2147/JMDH.S454985.

Predicting unmet activities of daily living needs among the oldest old with disabilities in China: a machine learning approach.

Wang K, Zhao J, Hu J, Liang D, Luo Y Front Public Health. 2023; 11:1257818.

PMID: 37771828 PMC: 10523409. DOI: 10.3389/fpubh.2023.1257818.

Using decision tree analysis to identify population groups at risk of subjective unmet need for assistance with activities of daily living.

Jaehn P, Fugemann H, Godde K, Holmberg C BMC Geriatr. 2023; 23(1):543.

PMID: 37674137 PMC: 10483760. DOI: 10.1186/s12877-023-04238-w.

Using More Equitable Integrated Care Programs to Reduce Fragmentation in Home Care.

MacLeod K Int J Integr Care. 2022; 22(3):17.

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Design, implementation and evaluation of informal home care support intervention program for lonely older adults in the community: Protocol for a feasibility study.

Lotfalinezhad E, Nadrian H, Kousha A, Andersen-Ranberg K, Jafarabadi M, Sohrabi A PLoS One. 2022; 17(8):e0273924.

PMID: 36044533 PMC: 9432751. DOI: 10.1371/journal.pone.0273924.

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