Abstract
BackgroundIntegrated neighborhood approaches (INAs) are increasingly advocated to reinforce formal and informal community networks and support community-dwelling older people. They aim to augment older people’s self-management abilities and engage informal networks before seeking professional support. INAs’ effectiveness however remains unknown. We evaluated an INA’s effects on older people’s (health-related) quality of life (HRQoL) and well-being in Rotterdam.MethodsWe used a matched quasi-experimental design comparing INA with “usual” care and support. Community-dwelling frail older (70+ years) people and frailty- and gender-matched control subjects (n = 186 each) were followed over a 1-year period (measurements at baseline and 6 and 12 months). Primary outcomes were HRQoL (EQ-5D-3L, SF-20) and well-being [social production function instrument for the level of well-being (SPF-IL)]. The effect of INA was analysed using an “intention to treat” and an “as treated” approach.ResultsThe results indicated that pre-intervention participants had lower incomes and were significantly older, more often single, less educated and more likely to have ≥1 disease than control subjects; they had lower well-being, physical functioning, role functioning, and mental health. Generalized linear mixed modelling of repeated measurements revealed no substantial difference in well-being or HRQoL between the intervention and control group after 1 year. The small differences we did find in the intention to treat group though were in favour of the control subjects (SF-20 = 6.98, 95 % confidence interval [CI] = 2.45–11.52; SPF-IL = .09, 95 % CI = .01–.17). However, the difference in well-being (SPF-IL) disappeared in the as treated analysis.ConclusionsThe lack of effects of INA highlights the complexity of integrated care and support initiatives. Barriers associated with meeting the complex, varied needs of frail older people, and those related to dynamic political and social climates challenge initiative effectiveness.Trial registration The research was supported with a grant provided by the Netherlands Organisation for Health Research and Development (ZonMw, project number 314030201) as part of the National Care for the Elderly Programme
Highlights
Integrated neighborhood approaches (INAs) are increasingly advocated to reinforce formal and informal community networks and support community-dwelling older people
The INA aims to overcome barriers associated with the provision of care and support in the Netherlands, which is often characterized as reactive, i.e., lacking a proactive and preventive approach that aims to protect older people’s quality of life, and fragmented, i.e., lacking a coordinated approach to health and social care service provision
One‐year changes in well‐being and quality of life No substantial difference in well-being or quality of life was observed between the intervention and control group at 1 year (T2) in analyses adjusted for time, age, sex, educational level, income, living situation, morbidity, frailty, and baseline scores
Summary
Integrated neighborhood approaches (INAs) are increasingly advocated to reinforce formal and informal community networks and support community-dwelling older people. They aim to augment older people’s self-management abilities and engage informal networks before seeking professional support. The INA aims to overcome barriers associated with the provision of care and support in the Netherlands, which is often characterized as reactive, i.e., lacking a proactive and preventive approach that aims to protect older people’s (healthrelated) quality of life, and fragmented, i.e., lacking a coordinated approach to health and social care service provision. When care and support cannot be provided for by older people themselves or their informal network for objective reasons, such as insufficient economic means and/or the absence of informal caregivers, do municipalities have a mandatory responsibility to compensate for older people’s limitations in various areas, such as transport or household support
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