The effects of a nurse-led home-based health-social partnership programme for the community-dwelling elderly in Hong Kong : a randomized controlled trial

Abstract

Background: Globally societies are faced with an aging population that is accompanying by functional disabilities and chronic diseases that tend to tax hospital use heavily. Aging in place (AIP) is a new idea that encourages the elderly to live in the community with autonomy and independence, thus helping to reduce hospitalization and minimize the fiscal burden on the health-care system. Self-care is an integral behavior that older adults have to initiate and perform on a daily basis in order to age in place. Many of the existing self-care programs are either disease-or hospital-based, implying that they provide supportive transitional programs to older adults recently discharged from hospital or who have complex and intensive needs. Older adults who have chronic diseases but are functionally independent are rarely a focus of attention for care. In fact, they often encounter health and social issues in their daily living that are similar to those experienced by frail older adults, such as difficulty adhering to a medication regimen, poor knowledge of available health care and social services, and impaired ability to manage daily activities. This group of older adults warrants more attention from community-integrated teams that include health and social partners to enable them to stay in the community and prevent their possible functional decline. Currently, the concept of health-social partnerships is promoted widely, but its implementation is still not fully developed and grounded in practice. In order to meet the long-term health and social needs of older adults adequately, there is an urgent need for researchers to put health-social partnerships into practice and develop proactive and sustainable self-care supportive programs in the community. Aim: The aim of this study was to test the effectiveness of a nurse-led home-based health-social partnership programme for community-dwelling older adults. Design and Methods: A randomized controlled trial was conducted in multiple districts in Hong Kong. A sample of 457 older adults, at least 60 years of age, from the community were assigned randomly to either an intervention group (n=230) or a control group (n=227). The intervention group received a three-month home-based health-social partnership programme delivered by nurse case managers who were supported by a team that included social workers and community workers. Structured home visits and telephone follow-up were the care-delivery strategies, and all nursing interventions were theory-based and protocol-driven. The control group received a placebo social call each month of this 3-month programme. Generalized Estimating Equation (GEE) was adopted to determine the changes or differences between the study group and control group (between group effects), within group (time) effects, and the interaction effects (group X time). Intention-to-treat (ITT) was used as the primary analysis in this study. Both modified Intention-to-treat (mITT) and Per-Protocol (PP) analysis were adopted as secondary analysis and performed separately. Self-efficacy was the primary outcome. Secondary outcomes included quality of life, depression level, life satisfaction, blood pressure, body mass index, medication adherence, basic and instrumental activities of daily living, and institutionalization and health service utilization. The outcomes were measured twice, pre-intervention (T1) and immediately post-intervention (T2). Results: The analysis showed that the intervention group had a significantly higher score in self-efficacy (p = .049), ADL (p = .012), IADL (p = .021) and physical components of quality of life (p < .001) at T2 than at T1. There was no significant group differences in self-efficacy. The program significantly improved the mental component of quality of life (p < .001) and medication adherence (p < .001), as well as reducing the total number of health service attendances compared to the control group (p = .016). Conclusion: The findings supported that the nurse-led home-based health-social partnership programme can help enhance the self-efficacy of community-dwelling elderly in self-care, which may in turn facilitate older adults to stay in the community with optimal well-being.