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Complex Interventions For Elderly People Can Be Beneficial
According to a meta-analysis published in The Lancet,
elderly people can improve physical function and live more
independently if provided with complex interventions such as preventive
home visits and community-based care after hospital discharge. The
study of over 90,000 elderly people also led authors to conclude that
well-developed services for the elderly should not be withdrawn.
Elderly
people tend to have reduced physical capabilities, which leads to
increased dependence on others, a need for hospital and long-term
nursing-home care, and premature death. Community-based complex
interventions seek to preserve physical function and independence in
elderly people. Researchers were interested in assessing the efficacy
of interventions such as preventive home visits, care
after hospital discharge, fall prevention, and education and
counseling in a group setting.
The meta-analysis, performed by Andrew Beswick,
Department of Social Medicine, University of Bristol, UK, and
colleagues, included a systematic review on data from 89 trials. The
data consisted of 97,984 people, averaging 65 years of age, who have
been living home and had at least six months of follow-up.
The researchers focused on the outcomes of living at home, death,
nursing home admission, hospital admission, falls, and physical
functions. One typical study that concentrated on these outcomes was
the
Medical Research Council trial of assessment and management of elderly
people in the community.
Results of the meta-analysis include:
Complex interventions were associated with:
a 13% reduced risk of nursing-home admission, and
therefore
improved the chances of living at home
a 6% reduced risk of hospital admissions
a 10% reduced risk in the occurrence of falls
Those who received intervention also improved physical
function
There was no impact on the risk of death
The authors note that admission rates to nursing homes were lower in
trials that reported higher death rates for the complex intervention
groups.
Results were also different depending on the time period of the trial.
Studies that started before 1993 were more likely to show benefits of
complex intervention. The period immediately before this, the 1980s to
1990s, was a period of great change in elderly care. During
this time, general practice began to include certain principals of
effective care.
Beswick and colleagues point out that the specific type or intensity of
intervention did not necessarily have an impact on the benefits. They
suggest that it could be wise to tailor different types of care to the
specific needs and desires of individuals, which could lead to
improved care response and adherence without losing any potential
benefits.
"Our systematic review and
meta-analysis showed that complex interventions can help elderly people
to continue living at home, largely through prevention of the need for
nursing home care, and can help to reduce the rate of falls," conclude
to the authors. "Complex interventions can help elderly people to live
safely
and independently, and could be tailored to meet individuals' needs and
preferences. We believe that our general conclusion, drawn from all the
available randomised evidence...suggests that a withdrawal of existing
well developed services [for the elderly] would be inappropriate."
Dr. David Stott, Academic Section of Geriatric
Medicine, University of Glasgow, and Glasgow Royal Infirmary, UK, and
colleagues write in an accompanying editorial: "There are major
challenges in the establishment of
access to multifactorial intervention for frail older people living in
the community. The numbers of qualified health-care workers are
limited, and the number of older people that might benefit is growing.
However, benefits will be maximised if we avoid ineffective or poorly
coordinated systems of care, and concentrate on trying to replicate
what we know works. It is vital we get this right - there is the
potential to improve the quality of life for elderly people and their
carers, and possibly even to reduce the costs of health and social
care."
Complex interventions to improve physical function and
maintain independent living in elderly people: a systematic review and
meta-analysis
Andrew D Beswick, Karen Rees, Paul Dieppe, Salma Ayis, Rachael
Gooberman-Hill, Jeremy Horwood, and Shah Ebrahim
The Lancet
(2008). 371:725-735
doi:10.1016/S0140-6736(08)60342-6
Click
Here to View Abstract
Written by: Peter M Crosta
Copyright: Start Sanatate
Not to be reproduced without permission of Start Sanatate
Complex de intervenþii pentru persoanele în vârstã poate fi beneficã - Complex Interventions For Elderly People Can Be Beneficial - articole medicale engleza - startsanatate