A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people

Fleming, Sarah A.; Blake, Holly; Gladman, John R.F.; Hart, Elizabeth; Lymbery, Mark; Dewey, Michael E.; McCloughry, Helen; Walker, Marion F.; Miller, Paul

Abstract

Objectives: to evaluate the effect of a care home rehabilitation service on institutionalisation, health outcomes and service use.

Design: randomised controlled trial, stratified by Barthel ADL index, social service sector and whether living alone. The intervention was a rehabilitation service based in Social Services old people's homes in Nottingham, UK. The control group received usual health and social care.

Participants: 165 elderly and disabled hospitalised patients who wished to go home but were at high risk of institutionalisation (81 intervention, 84 control).

Main outcome measures: institutionalisation rates, Barthel ADL index, Nottingham Extended ADL score, General Health Questionnaire (12 item version) at 3 and 12 months, Health and Social Service resource use.

Results: the number of participants institutionalised was similar at 3 months (relative risk 1.04, 95% confidence intervals 0.65–1.65) and 12 months (relative risk 1.23, 95% confidence intervals 0.75–2.02). Barthel ADL Index, Nottingham Extended ADL score and General Health Questionnaire scores were similar at 3 and 12 months. The intervention group spent significantly fewer days in hospital over 3 and 12 months (mean reduction 12.1 and 27.6 days respectively, P < 0.01), but spent a mean of 36 days in a care home rehabilitation service facility.

Conclusions: this service did not reduce institutionalisation, but diverted patients from the hospital to social services sector without major effects on activity levels or well-being.

Citation

Fleming, S. A., Blake, H., Gladman, J. R., Hart, E., Lymbery, M., Dewey, M. E., McCloughry, H., Walker, M. F., & Miller, P. (in press). A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people. Age and Ageing, 33(4), https://doi.org/10.1093/ageing/afh126

• Journal Article Type: Article
• Acceptance Date: Feb 5, 2004
• Online Publication Date: May 19, 2004
• Deposit Date: Dec 13, 2016
• Publicly Available Date: Dec 13, 2016
• Journal: Age and Ageing
• Print ISSN: 0002-0729
• Electronic ISSN: 1468-2834
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 33
• Issue: 4
• DOI: https://doi.org/10.1093/ageing/afh126
• Keywords: health services for the aged, rehabilitation, care homes, randomised controlled trial, elderly
• Public URL: https://nottingham-repository.worktribe.com/output/703192
• Publisher URL: http://ageing.oxfordjournals.org/content/33/4/384
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people / Sarah A. Fleming , Holly Blake, John R.F. Gladman, Elizabeth Hart, Mark Lymbery, Michael E. Dewey, Helen McCloughry, Marion Walker and Paul Miller is available online at: http://ageing.oxfordjournals.org/content/33/4/384
• Contract Date: Dec 13, 2016