Health Care Use in the Randomized Controlled Trial “Continuum of Care for Frail Elderly People”

Abstract

Dependence in the Activities of Daily Living (ADL) is associated with increased health care consumption. This study aimed to determine if an intervention involving a continuum of care for frail elderly people reduced the use of in-hospital and outpatient care; and if healthcare use differed by subgroups based on ADL dependence. This was a non-blinded randomized controlled trial. Participants (n=161) were aged 65-79 years with at least one chronic disease, and dependent in at least one activity of daily living (ADL); or aged 80+ years; and sought care at the emergency department. Exclusion criteria were immediate need of assessment and treatment by a physician, severe cognitive impairment, and palliative care. The intervention involved collaboration between a nurse with geriatric competence based in the emergency department, hospital wards, and a municipality-based multi- professional team with a case manager that provided care for the elderly people, care planning in the home, and active follow-up. Participants were divided into subgroups based on ADL dependence during the analysis. In the intervention group, participants classified as independent in ADL had fewer visits to a physician compared with the control group. The intervention group received more home visits by occupational therapists/physiotherapists, probably attributed to the rehabilitation inherent to the intervention. Time to first readmission was almost twice as long for independent participants in the intervention group compared with the control group (not statistically significant). Further research with a larger sample size and longer follow-up is needed to confirm if the intervention also reduces in-hospital care.