Where\u2019s the evidence? a systematic review of economic analyses of residential aged care infrastructure

Tiffany Easton,Rachel Milte,Julie Ratcliffe,Maria Crotty

doi:10.1186/s12913-017-2165-8

Abstract

BackgroundResidential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes. This review aimed to summarise the existing literature of economic evaluations of residential care infrastructure.MethodsA systematic review of English language articles using AgeLine, CINAHL, Econlit, Informit (databases in Health; Business and Law; Social Sciences), Medline, ProQuest, Scopus, and Web of Science with retrieval up to 14 December 2015. The search strategy combined terms relating to nursing homes, economics, and older people. Full economic evaluations, partial economic evaluations, and randomised trials reporting more limited economic information, such as estimates of resource use or costs of interventions were included. Data was extracted using predefined data fields and synthesized in a narrative summary to address the stated review objective.ResultsFourteen studies containing an economic component were identified. None of the identified studies attempted to systematically link costs and outcomes in the form of a cost-benefit, cost-effectiveness, or cost-utility analysis. There was a wide variation in approaches taken for valuing the outcomes associated with differential residential care infrastructures: 8 studies utilized various clinical outcomes as proxies for the quality of care provided, and 2 focused on resident outcomes including agitation, quality of life, and the quality of care interactions. Only 2 studies included residents living with dementia.ConclusionsRobust economic evidence is needed to inform aged care facility design. Future research should focus on identifying appropriate and meaningful outcome measures that can be used at a service planning level, as well as the broader health benefits and cost-saving potential of different organisational and environmental characteristics in residential care.Trial registrationInternational Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42015015977.

Highlights

IntroductionResidential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes
Residential care infrastructure, in terms of the characteristics of the organisation and the physical environment, have been found to directly influence resident outcomes
The organisational environment or infrastructure is widely discussed in residential aged care settings, in terms of both characteristics of the organisation, and the physical environment

Summary

Introduction

Residential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes. Recent literature suggests that for people with dementia with high levels of physical dependence, residential care can be less costly to provide at a societal level than homebased care [10,11,12]. This is primarily because of the high informal care costs for society arising from time spent by family and friends on supervision and care in home based settings [10, 11]. Higher rates of depressive symptoms have been linked to larger facilities as well as facilities located in non-urban areas [15]

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