JAMDA
Volume 9, Issue 5 , Pages 337-341, June 2008

Case Management, Preventive Strategies, and Caregiver Attitudes Among Older Adults in Home Care: Results of The ADHOC Study

  • Graziano Onder, MD, PhD
    • ,
  • Rosa Liperoti, MD, MPH
    • ,
  • Roberto Bernabei, MD
    • ,
  • Francesco Landi, MD, PhD

      Affiliations

    • Corresponding Author InformationAddress correspondence to Francesco Landi, MD, PhD, Centro Medicina dell'Invecchiamento (CEMI), Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168 Roma, Italy.

Department of Gerontology, Geriatrics and Physiatry, Catholic University of Sacred Heart, Roma, Italy.

published online 01 May 2008.

Background

Among older adults, integration of health services in a continuum of care with case management programs was shown to reduce progression of functional decline, hospitalization, and institutionalization. We hypothesized that such an approach may also result in a higher rate of use of preventive strategies and lower caregiver distress.

Methods

Data were from the baseline assessment of the AgeD in HOme Care project, a study enrolling subjects aged 65 years or older receiving home care in Europe. Preventive strategies considered were: (1) blood pressure measured in the last 2 years; (2) influenza vaccination in the last 2 years; (3) medication reviewed in the last 180 days.

Results

Mean age of participants was 82.3 years and 2971 (74%) were women; 1539 (38%) received home care program based on case management. Overall, 1350 (88%) of 1539 participants in the case manager group and 2046 (83%) of 2468 of those in the no case manager group had blood pressure measured in the last 2 years (P < .001). After adjusting for potential confounders, this result was still statistically significant (OR 1.31, 95% CI: 1.08–1.59). Similarly, more participants in the case manager groups received influenza vaccination (1083/1539 [70%] versus 1293/2468 [52%], P < .001) and had medication reviewed (312/1539 [20%] versus 356/2468 [15%], P < .001) compared with those in the no case manager group and these associations were confirmed after adjusting for confounders (OR: vaccination 2.08, 95% CI: 1.81–2.39; medication review 1.69, 95% CI 1.42–2.01). Furthermore, the caregivers of subjects in case manager group were less likely to be unable to continue in caring activities (49/1320 [4%] versus 134/2129 [6%], P = .01) and less dissatisfied (28/1320 [2%] versus 83/1129 [4%], P < .001) compared with those in the no case manager group.

Conclusions

Home care services based on case management approach result in a higher rate of use of preventive strategies and lower burden for caregivers.

Keywords: Home care, case manager, influenza vaccination, medication review, blood pressure, caregiver attitudes

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 The ADHOC project was funded by a grant from the Fifth Framework Programme on “Quality of Life and Management of Living Resources” of the European Union. None of the authors have any financial interests related to this article. None have conflicts of interest, financial arrangements, or consultantships with a company whose product is associated with the submitted manuscript.

PII: S1525-8610(08)00074-1

doi:10.1016/j.jamda.2008.02.002

JAMDA
Volume 9, Issue 5 , Pages 337-341, June 2008

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