The effectiveness of a coordinated preventive care approach for healthy ageing (UHCE) among older persons in five European cities: A pre-post controlled trial
The effectiveness of a coordinated preventive care approach for healthy ageing (UHCE) among older persons in five European cities: A pre-post controlled trial
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DOI：
10.1016/j.ijnurstu.2018.09.006
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发表时间：
2018-12-01
影响因子：
8.1
通讯作者：
Raat, Hein
中科院分区：
文献类型：
--
作者：
Franse, Carmen B.;van Grieken, Amy;Raat, Hein
背景：老年人往往有多种健康和社会问题，需要各种健康服务。综合提供保健和社会护理服务的协调一致的预防办法可促进健康老龄化。根据当地的情况和组织结构的不同，这种方法可以有不同的组织方式。目的：研究欧洲五个城市社区老年人的生活方式、健康状况和生活质量。设计：国际多中心事后对照试验。研究地点：英国、希腊、克罗地亚、荷兰和西班牙的城市社区环境。参与者：1844名社区老年人(平均年龄=79.5岁；方法：欧洲城市卫生中心(UHCE)的方法包括预防性的多维健康评估，如果一个人处于危险之中，则以跌倒风险、适当用药、孤独和虚弱为目标的协调护理路径。干预和控制地点是根据它们在参与城市中不同社区的位置来选择的。干预点“干预组”集水区的人员接受UHCE方法，而控制点“控制组”集水区的人员照常接受护理。在基线和一年的随访中进行问卷调查和两次测量，以评估健康的生活方式、跌倒的风险、适当的药物使用、孤独程度、脆弱程度、独立程度、与健康相关的生活质量和护理使用。结果：与对照组比较，干预组复发率较低(OR=0.65，95%CI=0.48；0.88)，脆弱程度较低(B=-0.43，95%CI=-0.65~-0.22)。与身体健康相关的生活质量和心理幸福感较好(B=0.95，95%CI=0.14~1.76；B=1.50，95%CI=0.15~2.84)。在参加护理路径的人群中，UHCE方法的效果更强(53.6%)。结论：我们的研究发现，使用协调的预防性卫生和社会护理方法来促进老年人的健康老龄化是有希望的，但效果不大。今后的研究应进一步评估旨在实现健康老龄化的协调的预防性保健和社会护理的效果。
Background: Older persons often have multiple health and social problems and need a variety of health services. A coordinated preventive approach that integrates the provision of health and social care services could promote healthy ageing. Such an approach can be organised differently, depending on the availability and organizational structures in the local context. Therefore, it is important to evaluate the effectiveness of a coordinated preventive care approach in various European settings.Objectives: This study explored the effects of a coordinated preventive health and social care approach on the lifestyle, health and quality of life of community-dwelling older persons in five European cities.Design: International multi-center pre-post controlled trial.Setting: Community settings in cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain.Participants: 1844 community-dwelling older persons (mean age = 79.5; SD = 5.6).Methods: The Urban Health Centres Europe (UHCE) approach consisted of a preventive multidimensional health assessment and, if a person was at-risk, coordinated care-pathways targeted at fall risk, appropriate medication use, loneliness and frailty. Intervention and control sites were chosen based on their location in distinct neighbourhoods in the participating cities. Persons in the catchment area of the intervention sites 'the intervention group' received the UHCE approach and persons in catchment areas of the control sites 'the control group' received care as usual. A questionnaire and two measurements were taken at baseline and at one-year follow-up to assess healthy lifestyle, fall risk, appropriate medication use, loneliness level, frailty, level of independence, health-related quality of life and care use. To evaluate differences in outcomes between intervention group and control group for the total study population, for those who received follow-up care-pathways and for each city separately (multilevel) logistic and linear regression analyses were used.Results: Persons in the intervention group had less recurrent falls (OR = 0.65, 95% CI = 0.48; 0.88) and lower frailty (B =-0.43, 95% CI = -0.65 to -0.22) at follow-up compared with persons in the control group. Physical health-related quality of life and mental well-being was better (B = 0.95; 95% CI = 0.14-1.76; and B = 1.50; 95% CI = 0.15-2.84 respectively). The effects of the UHCE approach were stronger in the subgroup of persons (53.6%) enrolled in care-pathways.Conclusions: Our study found promising but minor effects for the use of a coordinated preventive health and social care approach for the promotion of healthy ageing of older persons. Future studies should further evaluate effects of coordinated preventive health and social care aimed at healthy ageing.