Randomised controlled trial of health assessments for older Australian veterans and war widows

Abstract

Objective: To assess the effect of home‐based health assessments for older Australians on health‐related quality of life, hospital and nursing home admissions, and death. Design: Randomised controlled trial of the effect of health assessments over 3 years. Participants and setting: 1569 community‐living veterans and war widows receiving full benefits from the Department of Veterans’ Affairs and aged 70 years or over were randomly selected in 1997 from 10 regions of New South Wales and Queensland and randomly allocated to receive either usual care (n = 627) or health assessments (n = 942). Intervention: Annual or 6‐monthly home‐based health assessments by health professionals, with telephone follow‐up, and written report to a nominated general practitioner. Main outcome measures: Differences in health‐related quality of life, admission to hospital and nursing home, and death over 3 years of follow‐up. Results: 3‐year follow‐up interviews were conducted for 1031 participants. Intervention‐group participants who remained in the study reported higher quality of life than control‐group participants (difference in Physical Component Summary score, 0.90; 95% CI, 0.05–1.76; difference in Mental Component Summary score, 1.36; 95% CI, 0.40–2.32). There was no significant difference in the probability of hospital admission or death between intervention and control groups over the study period. Significantly more participants in the intervention group were admitted to nursing homes compared with the control group (30 v 7; P < 0.01). Conclusions: Health assessments for older people may have small positive effects on quality of life for those who remain resident in the community, but do not prevent deaths. Assessments may increase the probability of nursing‐home placement.

Self-Report of Healthcare Utilization among Community-Dwelling Older Persons: A Prospective Cohort Study

“…Participants lost to follow-up for other reasons more often had a non-Caucasian ethnic background, had a lower socioeconomic status, were more often disabled and were less able to participate. These findings are in accordance with the literature [8], [21]–[26], although some authors found no difference between responders and those lost to follow-up [28] or assumed nonselective loss to follow-up [9], [29].…”

“…Large national studies use surveys to routinely collect these self-reported data [4]–[9]. Self-report is mostly an effective and less time-consuming mode of collecting data on the utilization of healthcare resources compared to collecting data from medical records or administrative claims data.…”

“…Those who do not respond at follow-up are generally older [21]–[25],less educated [8], [25], have lower socioeconomic status [23], live alone [25], have more functional impairments [8], [21], [25], [26], suffer from more comorbidities [21], [22], and are more inaccurate in self-reporting costs compared with participants who completed the study [27]. However, others found no difference between respondents and those who were lost to follow-up, and assumed that attrition was non-selective [9], [28], [29]. However, more research is needed to investigate the relationship between loss to follow-up and healthcare utilization, to study the potential bias in self-reported healthcare utilization data in studies with a longitudinal design.…”

Comparison of the uptake of health assessment items for Aboriginal and Torres Strait Islander people and other Australians: Implications for policy

“…Ameliorating this situation may require not only further promotion of the items with doctors but further engagement of local primary health infrastructure and the community. [2,5] The evaluation of the HA items and previous initiatives to promote health checks[11] in Aboriginal and Torres Strait islander communities are valuable resources in developing approaches to ensure that the potential health benefit deriving from the new and existing items are delivered.…”

“…[2,3] No information was available on baseline levels for the provision of HAs but the evaluation did suggest that there was an increase in the use of HAs in case study practices and that reimbursement was an incentive to completing HAs in about one third of practices. Health benefits associated with HA among older patients were relatively small [4,5] and the evaluation suggested that further uptake was required to have significant impact on the health of the target populations. [3] This was particularly true of the items for Aboriginal and Torres Strait Islander people which were used at a significantly lower rate than the items for the general population.…”