Study protocol: older people in retirement villages. A survey and randomised trial of a multi-disciplinary invention designed to avoid adverse outcomes

K Peri,J B Broad,M J Connolly,Z Wu,D Bramley,J Hikaka,C Calvert,K Bloomfield,A Tatton,M Boyd,A-M Higgins

doi:10.1186/s12877-020-01640-6

Abstract

BackgroundThere is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence. Currently in New Zealand there is limited knowledge of the medical, service supports, social status and needs of RV residents. The objective of this study is to explore RV facilities and services, the health and functional status of RV residents, prospectively study their healthcare trajectories and to implement a multidisciplinary team intervention to potentially decrease dependency and impact healthcare utilization.MethodsAll RVs located in two large district health boards in Auckland, New Zealand were eligible to participate. This three-year project comprised three phases: The survey phase provided a description of RVs, residents’ characteristics and health and functional status. RV managers completed a survey of size, facilities and recreational and healthcare services provided in the village. Residents were surveyed to establish reasons for entry to the village and underwent a Gerontology Nurse Specialist (GNS) assessment providing details of demographics, social engagement, health and functional status. The cohort study phase examines residents’ healthcare trajectories and adverse outcomes, over three years. The final phase is a randomised controlled trial of a multidisciplinary team intervention aimed to improve health outcomes for more vulnerable residents.Residents who triggered potential unmet health needs during the assessment in the survey phase were randomised to intervention or usual care groups. Multidisciplinary team meetings included the resident and support person, a geriatrician or gerontology nurse practitioner, GNS, pharmacist and General Practitioner. The primary outcome of the randomised controlled trial will be first acute hospitalization. Secondary outcomes include all acute hospitalizations, long-term care admissions, and all-cause mortality.DiscussionThis paper describes the study protocol of this complex study. The study aims to inform policies and practices around health care services for residents in retirement villages. The results of this trial are expected early 2020 with publication subsequently.Trial registrationAustralia and New Zealand Clinical Trials Registry: ACTRN12616000685415. Registered 25.5.2016.Universal Trial Number (UTN): U111–1173-6083.

Highlights

There is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence
Long-term care (LTC) beds for those requiring 24-h care decreased by almost a third during this same time period, likely due to government policies that promoted community care and “ageing in place” [3,4,5]. This is likely to have resulted in a trend of increased physical dependency and healthcare complexity for those currently living in RVs [6, 7]
Forty-five percent had been assessed for publicly funded homecare help while 15% received help with personal cares. They had higher morbidity and need, including falls, general health, help with bathing/ dressing, and cognition. These findings suggest that physical function of RV residents lies between those living in private homes and those in long-term care (LTC)

Summary

Introduction

There is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence. Long-term care (LTC) beds for those requiring 24-h care decreased by almost a third during this same time period, likely due to government policies that promoted community care and “ageing in place” [3,4,5]. This is likely to have resulted in a trend of increased physical dependency and healthcare complexity for those currently living in RVs [6, 7]. There were almost no RV residents in NZ in the late 1980s, yet by 2017 an estimated 12.6% of people of 75 years and over in NZ lived in RVs [8]

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