Hugh Senior is an epidemiologist at the University of Queensland, Australia, and Matthew Parsons is a gerontologist at the University of Auckland, New Zealand. Their paper Promoting independence in frail older people: a randomised controlled trial of a restorative care service in New Zealand has recently been published in Age and Ageing journal.
Many older people will experience a decline in their level of physical function during the period of developing an acute illness that requires hospitalisation and discharge from hospital. A third will be discharged from hospital having not recovered the level of function that they had prior to becoming unwell. The loss of physical function includes losses in key areas required for independent living such as dressing, bathing, getting out of bed or a chair, toileting, eating and walking across a room. As such, this has an impact on the older person’s ability to live independently and safely at home, and increases both the likelihood that the older person will need to reside at a residential care facility and the likelihood of death. A possible intervention to help older people with hospital associated disability is to provide restorative rehabilitation after discharge from hospital, for those who may benefit, with an aim to return to a level of independence where they can return to their own home.
A residential based restorative care rehabilitation programme called The Promoting Independence Programme (PIP) service in Wellington, New Zealand, was selected as it provided restorative care rehabilitation. The service was broadly separated into two parts, the first was at a residential care facility after hospital discharge which was delivered and case managed by a multi-disciplinary team, and the second continued in the older person’s own home once they had sufficient capacity to return home.
The ASPIRE trials were established in New Zealand in 2003 to evaluate different models of care for frail older people that aimed to decrease mortality and to allow older people to remain living at home, rather than entering a residential aged care facility. The evaluation of the PIP service in Wellington was one of the models chosen for the ASPIRE trials.
For this study, we identified frail older people on discharge from hospital who had a level of physical disability that meant that they could not independently and safely live at home, but with restorative care rehabilitation from a multi-disciplinary team and provided they had good housing, social support and domiciliary care, are likely to be able to return to living in the community at their own home or at a relatives.
The trial obtained high level evidence on whether older people receiving the PIP services would have a lower risk of entering residential aged care facilities and/or dying than those receiving usual care services on hospital discharge. Also assessed were the impact of the PIP service on a range of physical function, cognitive function, and psychosocial outcomes as well as caregiver burden.
Our main finding was that restorative rehabilitation care services which incorporate case management and multi-disciplinary team care may positively impact on the risk of residential care placement and/or death, without increasing caregiver burden.