Elderly care across time and countries, in Europe, with help of interrai-instruments

Transcription

1 Symposium SS 2.04 The EU-GMS congress September 2014 in Rotterdam Elderly care across time and countries, in Europe, with help of interrai-instruments In this symposium we utilized three EU-funded scientific projects 1) AD-HoC in ) SHELTER and 3) IBenC Care recipients have been assessed in a consistent way by trained staff, and data from the staff is available. Therefore care practices and outcomes can be compared from various aspects.. This symposium was chaired by Roberto Bernabei. He is professor of internal medicine since year 2000, at the Universita Cattolica del Sacro Cuore, Rome, Italy. More than 300 of his publications can be found in the PubMed today, and considerable number of them has been produced in international collaboration. Among numerous tasks and achievements prof. Roberto Bernabei is board member of EAMA, has acted as project leader for European Union funded projects Ad-HoC, and SHELTER, and as president of Società Italiana di Gerontologia e Geriatria Chair: prof. Roberto Bernabei (Italy) Co-chair prof Hein van Hout (The Netherlands) Coordinator prof Harriet Finne-Soveri (Finland) The sympostium took place 18 th September I ) Title The effects of innovation in home care on (re)hospitalization and institutionalization: results from the Belgian Protocol 3- study. Presenting; prof Anja DeClercq (Belgien) Co-authors : Johanna de Almeida Mello, Sophie Cès, Thérèse Van Durme & Jean Macq Belgium has a greying population, with growing waiting lists for nursing homes and more and more older people being admitted to hospitals. With that in mind, along with the fact that most people prefer to stay at home, the Belgian government financed 64 innovative projects aimed at keeping people with a nursing home profile at home by providing a new kind of service, during a four year period. Of every person participating in the projects, the following data were collected: interrai HC assessment at baseline, after six months and when leaving the project; health care consumption data; WHO Quality of Life Scale; Zarit Burden Scale of the main informal caregiver and data on costs both for the government and for the clients themselves. In this presentation, we will show whether, why, and to what extent the projects diminished (re)hospitalization and postponed or avoided moving to a nursing home.

2 II) Title: Validating MAPLe algorithm for 11 European countries Presenting: prof Harriet Finne-Soveri (Finland) Co-authors; Bernabei R, Garms-Homolová V, Frijters D, Henrard J-C, van Hout H, Jokinen S, Jónsson PV, Noro A, Onder G, van den Roest H, Topinková E, Vilkko A. The algorithm for setting priority levels for care in the frail community dwelling older persons has been created and validated in Canada and in the acute care hospitals in the Nordic countries but not among home care recipients, in Europe. We used European union 5 th framework funded project data, collected in 11 European countries during , to investigate whether this algorithm embedded in the interrai questionnaire called RAI-home care (version 2,0) to evaluate whether MAPLe-algorthm predicts informal care-giver burden, and willingness to move away from home among home care recipients in Europe. Informar caregiver's view: Better off someplace else (%) Care giver stressed,(%) 35% 30% 25% 20% 15% 10% 5% 0% Very low priority (n=507) Low priority (n=281) Some priority (n=1005) High priority (n=766) Very High priority (n=272) Figure II.1. Informal caregiver stress and hor/her wish to find another living place for the home-care recipient than home Care giver burden Better off someplace else Figure II.2. Independent predictors for care-giver burden and better-off someplace else Conclusion: Maple-algorithm predicts care giver stress and his her wish to send the care recipient someplace else to live.

3 III) Title: Seeking rationality: what Determines formal and informal care costs among European older adults in home care? Presenting: prof Hein van Hout (The Netherlands) Co-authors; L van Lier 1, H van der Roest 1, K Joling 1, J Bosmans Over the last decades, European countries have been undergoing a process of population ageing which has put much pressure on the sustainability of national healthcare systems. As a consequence, the focus of many healthcare systems gradually shifted from institutionalized care toward home and community-based care since the latter is expected to be a (cost-) effective alternative. Nowadays, home health care and social care services are used widely across Europe and insight into the costs associated with health care utilization of home care users aged 65+ within and across European countries is needed. We used data from the Aged in HOme Care project (AdHOC) to calculate and compare the health care and social care utilization rates over an one-year period and its costs of community dwelling older adults across six European countries. Furthermore, we investigated whether and to what extent the total care costs can be predicted by individual client characteristics (social, functional and clinical). We found large variations of costs of resource utilisation across countries. Country appeared to be by fare the most important determinant. This study demonstrates that although within countries, resource use may be driven by clinical needs, country health care systems were a much stronger determinant. This questions current level of rationality in Europe s resource utilisation.

4 IV) Title: Drug use in long term care Presenting: prof Graziano Onder (Italy) Nursing home (NH) residents represent the paradigm of this complexity, since they are usually 'frail' and present with multiple chronic diseases and with a high rate of functional and cognitive impairment. Pharmacological treatment of this complex patient represents a challenge for prescribing physicians, as confirmed by the high prevalence of polypharmacy, defined as the concomitant use of multiple drug therapies, and resulting iatrogenic illness observed in this population. We have examined data from older adults in NH in European countries from the Services and Health for Elderly in Long TERm care (SHELTER) project showing that polypharmacy (use of 5 to 9 drugs) and excessive polypharmacy (use of 10 drugs) are extremely common in this sample (49.7% and 24.3% respectively). As compared with non-polypharmacy, excessive polypharmacy was directly associated not only with presence of chronic diseases, but also with depression (OR 1.81; 95% CI ), pain (OR 2.31; 95% CI ), dyspnoea (OR 2.29; 95% CI ), GI symptoms (OR 1.73; 95% CI ). An inverse association with excessive polypharmacy was shown for age (OR for 10 years increment 0.85; 95% CI ) ADL disability (OR for assistance required vs. independent 0.90; 95% CI ; OR for dependent vs. independent 0.59; 95% CI ) and cognitive impairment (OR for mild/moderate vs. intact 0.64; 95% CI ; OR for severe vs. intact 0.39; 95% CI ). These data suggest that the use of multiple drugs is extremely common among NH residents and that use of drugs is influenced not only by comorbidity, but also by non clinical conditions, including functional and cognitive status Conclusions were: 1. Several factors should be considered when prescribing in NH residents, including cognitive status/dementia, limited life expectancy, disability, multimorbidity. 2. CGA + medication review may provide an optima approach to improve prescribing 3. Use of inappropriate drugs should be avoided V) Title Quality of care: Focus on medication use and the relationship between the organization of long term care facilities in Europe Presenting: H.G. van der Roest (The Netherlands); Co-authors: D.H.M. Frijters, G. Onder, the SHELTER project Background: Care practice in long-term care differs across countries and facilities. The organization of care could affect the quality of delivered care, but it is not clear in what way exactly. In the SHELTER study we explored differences between European long-term care facilities and the relationship between country specific organizational characteristics of long-term health care and quality of care. This study will focus on the use of medications in long term care and their relationship with nursing home characteristics. The use of medications like antidepressants and antipsychotics are largely reliant on patient characteristics. But since the large quality differences were found with regard to these types of drugs between facilities, facility characteristics might explain a part of the variation. Method: The SHELTER study had a longitudinal design patients from 57 long- term care facilities in eight European countries were included in the study. Patient health status was comprehensively assessed with the interrai-ltcf, of which quality indicators (QIs), case-mix indexes, and validated scales on patient

5 functioning can be calculated. At baseline additional information on structure and process characteristics (e.g. size, staff formation, education) of the participating long-term care facilities was gathered with the use of a specially designed form. Results and discussion: Linear regression analysis showed a positive relationship for nursing time and public ownership of a facility on mean number of used drugs, while facilities in Italy and Israel showed an inverse relationship on the mean number of used drugs. Also nursing time was positively related to good care on low risk antipsychotic prevalence. The results of this study provide limited evidence on the relationship between structural/process factors and medication use. This might be contributed to a lack of validated questionnaires to inventorise structural and process characteristics of care organizations over countries. More insight into organizational characteristics of long term care facilities, might give practitioners and policy makers better direction to target factors within their organization that could be changed in order to positively affect the quality of delivered care.