Abstract
BackgroundFrail and dependent older people in resource-poor settings are poorly served by health systems that lack outreach capacity. The COPE (Caring for Older PEople) multidimensional assessment tool is designed to help community health workers (CHWs) identify clinically significant impairments and deliver evidence-based interventionsMethodsOlder people (n = 150) identified by CHWs as frail or dependent, were assessed at home by the CHW using the structured COPE assessment tool, generating information on impairments in nutrition, mobility, vision, hearing, continence, cognition, mood and behaviour. The older people were reassessed by local physicians who reached a clinical judgment regarding the presence or absence of the same impairments based upon clinical examination guided by the EASY-Care assessment tool.ResultsThe COPE tool was considered easy to administer, and gave CHWs a sense of empowerment to understand and act upon the needs of older people. Agreement between COPE assessment by CHW and clinician assessors was modest (ranged from 45.8 to 91.3 %) for most impairments. However, the prevalence of impairments was generally higher according to clinicians, particularly for visual impairment (98.7 vs 45.8 %), cognitive impairment (78.4 vs. 38.2 %) and depression (82.0 vs. 59.9 %). Most cases identified by WHO-COPE were clinician confirmed (positive predictive values - 72.2 to 98.5 %), and levels of disability and needs for care among those identified by COPE were higher than those additionally identified by the clinician alone.ConclusionsThe COPE is a feasible tool for the identification of specific impairments in frail dependent older people in the community. Those identified are likely to be confirmed as having clinically relevant problems by clinicians working in the same service, and the COPE may be particularly effective at targeting attention upon those with the most substantial unmet needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0121-1) contains supplementary material, which is available to authorized users.
Highlights
Frail and dependent older people in resource-poor settings are poorly served by health systems that lack outreach capacity
Studies conducted in Low And Middle Income Countries (LAMICs) indicate highly variable levels of utilization of government primary health care services among older people, with a preference for private doctor and hospital outpatient services in India and some Latin American countries [6]
A cadre of Auxiliary Nurse Midwives (ANM), often referred to as community health workers (CHWs) was introduced 50 years ago to increase the coverage of basic health care at the community level, and improve equity [10]
Summary
Frail and dependent older people in resource-poor settings are poorly served by health systems that lack outreach capacity. A recent systematic review concluded that, in primary care and community settings, interventions targeting risk factors and functional impairments may be more effective than disease specific interventions at alleviating burden in older people with complex multimorbidity [5] Such an approach may be salient to low and middleincome countries with few physicians, where nonspecialist community health workers could be used to improve the coverage of and access to health and social care. As the only branch of primary care offering outreach into the community, and with a family and household orientation to their work, CHWs are in principle ideally situated to implement age-appropriate care for older people; case-finding (identifying frail or dependent older people in the community, who have not sought help at the health facility), and home-based assessment and intervention to treat or mitigate the effects of impairments arising from chronic disease
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