Nurse-led health promotion interventions improve quality of life in frail older home care clients, with no additional health care costs, according to a new McMaster study.
As the population ages at an unprecedented rate, the researchers say now is the time to reinvest in new, more effective and efficient strategies to promote the health-related quality of life of seniors at home.
Over 90 per cent of those aged 65 and over live in the community, the study says. Frail older adults using home care services represent 75 to 80 per cent of home care users, and this segment of the senior population is at particularly high risk for things like falls, hospitalization or death. It is expected that by 2031, seniors will comprise 25 per cent of the Canadian population and that the number of frail seniors will rise as well. However, frailty is not inevitable with age. There are many preventable risk factors for functional decline and frailty, such as falls, depression, unhealthy diet, social isolation and physical inactivity.
In the research appearing online in the Journal of Evaluation in Clinical Practice, associate professor of nursing Maureen Markle-Reid and her colleagues summarize the results and lessons learned from a series of three nurse-led intervention studies she led between 2000 and 2009 as a principal investigator through a university-community partnership with four home care programs and 12 community-based agencies in Southern Ontario.
These health promotion and disease prevention interventions – featuring proactive, provider-initiated care in the home setting, in contrast to usual demand-led home care – sought to target risk factors for frailty. The studies involved a total of 498 frail older adults aged 65 or older. Randomized controlled trials lasting between six and twelve months were carried out with home visits by a nurse in collaboration with other health professionals.
Change in health-related quality of life was measured, as were health services usage costs. The researchers found that "Nurse-led HPDP interventions for frail older home care clients provide greater improvements in health-related quality of life (HRQOL) compared with usual home care,' and "can be implemented using existing home care resources.'
Markle-Reid said the series of studies are unique because there are very few, if any, intervention studies that have been conducted in the home care sector with frail older adults and their caregivers.
"A shift in focus is needed in home care policy from acute care and the treatment of physical disability to more health-oriented, preventive and comprehensive strategies to provide an adequate response to the complex needs of frail older adults,' said Markle-Reid, who is also acting assistant dean of research for the School of Nursing.
"Making strategic investments now in health promotion and disease prevention interventions will help mitigate risk factors for frailty, functional decline and loss of independence, so that living in one's own home, even with considerable challenges, can become a true reality for older people,' she added.