Effects of a continuum of care intervention on frail older persons’ life satisfaction: a randomized controlled study

Abstract

Aims and objectives The aim of this study was to analyse effects of a comprehensive continuum of care (intervention group) on frail older persons’ life satisfaction, as compared to those receiving usual care (control group). The intervention included geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care‐planning meetings in older persons’ own homes. Background Improvements in older persons’ subjective well‐being have been shown in studies including care planning and coordination by a case manager. However, effects of more complex continuum of care interventions on frail older persons’ life satisfaction are not well explored. Design Randomised controlled study. Methods The validated LiSat‐11 scale was used in face‐to‐face interviews to assess older persons’ life satisfaction at baseline and at three, six and 12 months after the baseline. The odds ratio for improving or maintaining satisfaction was compared for intervention and control groups from baseline to three‐month, three‐ to six‐month as well as six‐ to 12‐month follow‐ups. Results Older persons who received the intervention were more likely to improve or maintain satisfaction than those who received usual care, between 6 and 12 month follow‐ups, for satisfaction regarding functional capacity, psychological health and financial situation. Conclusions A comprehensive continuum of care intervention comprising several components had a positive effect on frail older persons’ satisfaction with functional capacity, psychological health and financial situation. Relevance to clinical practice Frail older persons represent a great proportion of the persons in need of support from the health care system. Health care professionals need to consider continuum of care interventions’ impact on life satisfaction. As life satisfaction is an essential part of older persons’ well‐being, we propose that policy makers and managers promote comprehensive continuum of care solutions.

Effect of a care process programme on frail older people’s life satisfaction

“…The difference in favour of the care process programme was detected later in time, between 6-12-month followups. Similarly, in the previous intervention project, an effect on life satisfaction was seen between 6-12-month follow-ups, in favour of the intervention (Berglund et al, 2015). The intervention project and the full-scale care process programme included case management, interprofessional teamwork and organizing of care-planning meetings in the older people's own homes.…”

“…For participants who died before any of the follow‐ups, worst‐case imputation was done (Eklund et al, ; Gustafsson et al, ; Polit & Gillespie, ). For participants who completed the study but did not have reported values at any of the measurement points, as well as for internal loss, we used the participants’ own obtained values at a different point in time (Berglund et al, ; Engels & Diehr, ; Polit, ). In one case in the historical control group and two cases in the care process programme, imputations were not possible due to missing data on all measurement points.…”

“…In a previous larger intervention project, Continuum of care for frail older people -a randomized controlled trail, we developed several components to create a comprehensive continuum of care, including case management, interprofessional teamwork and organizing careplanning meetings in the older people's own homes (Wilhelmson et al, 2011). We found positive results on frail older people's life satisfaction with respect to satisfaction with functional capacity and psychological health (Berglund, Hasson, Kjellgren, & Wilhelmson, 2015). The intervention also had a positive impact on older people's perceived quality of care (Berglund et al, 2013), frailty and independence in activities of daily living (Eklund, Wilhelmson, Gustafsson, Landahl, & Dahlin-Ivanoff, 2013), as well as on self-determination in daily life (Ekelund & Eklund, 2015).…”

“…own obtained values at a different point in time (Berglund et al, 2015;Engels & Diehr, 2003;Polit, 2010). In one case in the historical control group and two cases in the care process programme, imputations were not possible due to missing data on all measurement points.…”

The care‐planning conference: Exploring aspects of person‐centred interactions

“…When transferring from one provider to another, older people are at increased risk of falling through the cracks and experiencing incidents (for example, lack of treatment) and readmission due to poor communication and exchange of information among professionals and between professionals and the patient (Allen, Ottmann, & Roberts, ). Organizations and professions have their own legislations, values, responsibilities and budgets, and with this system, there is a risk of fragmentation and lack of continuity of the care provided (Berglund, Hasson, Kjellgren, & Wilhelmson, ; Sundström, Petersson, Rämgård, Varland, & Blomqvist, ). Collaboration among different professions in the community is complex and multifaceted (Rämgård, Blomqvist, & Petersson, ), and studies have identified various barriers and facilitators related to the organization of health care (Jansen, Heijmans, & Rijken, ).…”