Abstract
Background home advice and modification interventions aim to promote independent living for those living in the community, but quantitative evidence of their effectiveness is limited.Aim assess the risk of care home admissions for people with different frailty levels receiving home advice and modification interventions against a control group who do not.Study design and setting matched control evaluation using linked longitudinal data from the Secure Anonymised Information Linkage (SAIL) Databank, comprising people aged 60–95, registered with a SAIL contributing general practice. The intervention group received the Care & Repair Cymru (C & RC) service, a home advice and modification service available to residents in Wales.Methods frailty, age and gender were used in propensity score matching to assess the Hazard Ratio (HR) of care home admissions within a 1-, 3- and 5-year period for the intervention group (N = 93,863) compared to a matched control group (N = 93,863). Kaplan–Meier curves were used to investigate time to a care home admission.Results the intervention group had an increased risk of a care home admission at 1-, 3- and 5-years [HR (95%CI)] for those classified as fit [1-year: 2.02 (1.73, 2.36), 3-years: 1.87 (1.72, 2.04), 5-years: 1.99 (1.86, 2.13)] and mildly frail [1-year: 1.25 (1.09, 1.42), 3-years: 1.25 (1.17, 1.34), 5-years: 1.30 (1.23, 1.38)], but a reduced risk of care home admission for moderately [1-year: 0.66 (0.58, 0.75), 3-years: 0.75 (0.70, 0.80), 5-years: 0.83 (0.78, 0.88)] and severely frail individuals [1-year: 0.44 (0.37, 0.54), 3-years: 0.54 (0.49, 0.60), 5-years: 0.60(0.55, 0.66)].Conclusions HRs indicated that the C & RC service helped to prevent care home admissions for moderately and severely frail individuals. The HRs generally increased with follow-up duration.
Highlights
BackgroundHealthy ageing, maintenance of independence and reduced requirement for services are key challenges for policy makers, planners, commissioners and providers seeking to ensure sustainability of health and social care services internationally [1,2,3]
The Secure Anonymised Information Linkage (SAIL) Databank has a unique individual anonymised person identifier known as an anonymous linking field (ALF) and unique address anonymised identifier known as a residential ALF (RALF) [13] that are used to link between data sources at individual and residential levels, respectively
When stratifying the data by frailty category we see that, irrespective of the length of time, C & RC clients defined as fit and mildly frailty have an increased Hazard Ratio (HR) for care home admission compared to non-clients, whereas the moderate and severely frail individuals have a reduced HR
Summary
BackgroundHealthy ageing, maintenance of independence and reduced requirement for services are key challenges for policy makers, planners, commissioners and providers seeking to ensure sustainability of health and social care services internationally [1,2,3]. Projections of future care needs for older people in England and Wales indicate considerable challenges in this area, with an anticipated increase of 25% by 2025 [4]. These projections have major financial implications from an individual and societal perspective, with costs associated with residential and nursing home care notable. Care homes can help to provide essential care for those in need, older people typically prefer to remain living safely and independently in their own home wherever possible [6], or to relocate voluntarily for downsizing and convenience reasons [7]. A contributory factor is that primary research studies to evaluate interventions to prevent or delay transitions between independent living and care home residence are highly complex to implement, and resource intensive
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