Abstract
Background and aims: Community care for older people is increasing dramatically in most European countries as the preferred option to hospital andlong-term care. While there has been a rapid expansion in Evidence-Based Medicine, apart from studies of specific interventions such as home visiting and hospital at home (specialist visits or hospital services provided to people in their own homes in the community), there is little evidence of characteristics of the recipients of community care services or the organisation of services that produce the best outcomes for them and their informal carers. The AdHOC Study was designed to compare outcomes of different models of community care using a structured comparison of services and a comprehensive standardised assessment instrument across 11 European countries. This paper describes the study and baseline data. Methods: 4,500 people 65 years and older already receiving home care services within the urban areas selected in each country were randomly sampled. They were assessed with the MDS-HC (Minimum Data Set-Home Care) instrument, containing over 300 items, including socio-demographic, physical and cognitive characteristics of patients as well as medical diagnoses and medications received. These data were linked to information on the setting, services structures and services utilization, including use of hospital and long-term care. After baseline assessment, patients were re-evaluated at 6 months with an abbreviated version of the instrument, and then at the end of one year. Data collection was performed by specially-trained personnel. In this paper, socio-demographics, physical and cognitive function and provision of hours of formal care are compared between countries at baseline. Results: The final study sample comprised 3,785 patients; mean age was 82±7.2 years, 74.2% were females. Marital and living status reflected close family relationships in southern Europe relative to Nordic countries, where 5 times as many patients live alone. Recipients of community care in France and Italy are characterised by very high physical and cognitive impairment compared with those in northern Europe, who have comparatively little impairment in Activities of Daily Living and cognitive function. The provision of formal care to people with similar dependency varies extremely widely with very little formal care in Italy and more than double the average across all levels of dependency in the UK. Conclusions: The AdHOC study, by virtue of the use of a common comprehensive standardised assessment instrument, is a unique tool in examining older recipients of community care services in European countries and their widely varied organisation. The extreme differences seen in dependency and hours of care illustrate the probable contribution the study will make to developing an evidence based on the structure, quantity and targeting of community care, which will have major policy implications.
Similar content being viewed by others
References
Carpenter I, Challis D, Hirdes J, Ljunggren G, Bernabei R. Care of older people: a comparison of systems in North America, Europe and Japan. London: Farrand Press, 1999.
Meerding W, Polder J, Bonneux L, Koopmanschap M, Van der Maas P. Health-care costs of ageing. Lancet 1998; 351: 140–1.
Levine SA, Boal J, Boling PA. Home care. JAMA 2003; 290: 1203–7.
Woolhandler S, Campbell T, Himmelstein DU. Costs of health care administration in the United States and Canada. N Engl J Med 2003; 349: 768–75.
Welch HG, Wennberg DE, Welch WP. The use of Medicare home health care services. N Engl J Med 1996; 335: 324–9.
Burge F, Lawson B, Johnston G. Trends in the place of death of cancer patients 1992–1997. CMAJ 2003; 168: 265–70.
Steel K. Research on ageing: an agenda for all nations individually and collectively. JAMA 1997; 278: 1374–5.
Challis DJ. Care of the elderly in Europe. Eur J Gerontol 1992; 1: 334–47.
Saltman R, Figueras J. Analyzing the evidence of European health care reforms. Health Affairs 1998; 17: 85–106.
Ham C, Brommels M. Health care reforms in the Netherlands, Sweden and the United Kingdom. Health Affairs 1994; 13: 106–19.
CM5571. 2002 Spending Review: Public Service Agreements. London: HMSO, 2002.
Carpenter GI, Mor V, Phillips C. Continuing and rehabilitative care for the elderly: a comparison of countries and settings. Oxford: Age Ageing Suppl, 1997.
van Haastregt JCM, Diederiks JPM, van Rossum E, de Witte LP, Crebolder HFJM. Effects of preventive home visits to elderly people living in the community: systematic review. BMJ 2000; 320: 754–8.
Gentles H, Potter J. Alternatives to acute hospital care. Rev Clin Gerontol 2001; 11: 373–8.
Vetter NJ, Lewis PA, Ford D. Can health visitors prevent fractures in elderly people? BMJ 1992; 304: 888–90.
van Haastregt JCM, Diederiks JPM, van Rossum E, de Witte LP, Voorhoeve PM, Crebolder HFJM. Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk. BMJ 2000; 321: 994–8.
Stuck AE, Aronow HU, Steiner A, et al. A trial of annual comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995; 333: 1184–9.
Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032–6.
Williams EI, Greenwell J, Groom LM. The care of people over 75 years of age after discharge from hospital: an evaluation of timetabled visiting by health visitor assistants. J Public Health Medicine 1992; 14: 138–44.
Dunn RB, Lewis PA, Vetter NJ, Guy PM, Hardman CS, Jones RW. Health visitor intervention to reduce days of unplanned hospital re-admission in patients recently discharged from geriatric wards: the results of a randomised controlled study. Arch Gerontol Geriatr 1994; 18: 15–23.
Elkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ 2001; 323: 1–9.
Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 2002; 287: 1022–8.
Illsley R. In Jamieson A, ed. Home care for older people in Europe: a comparison of policies and practices. Oxford: Oxford University Press, 1991.
Bernabei R, Landi F, Gambassi G, et al. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ 1998; 316: 1348–51.
Bula CJ, Berod AC, Stuck AE, et al. Effectiveness of preventive in-home geriatric assessment in well functioning, community-dwelling older people: secondary analysis of a randomized trial. J Am Geriatr Soc 1999; 47: 389–95.
Reuben DB, Frank JC, Hirsch SH, McGuigan KA, Maly RC. A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations. J Am Geriatr Soc 1999; 47: 269–76.
Rubenstein L, Wieland D, Bernabei R. Geriatric Assessment Technology: the state of the art. Milan: Editrice Kurtis, 1995.
HennekensCH, Buring JE, Mayrent SL. Epidemiology in Medicine, 1987.
Morris JN, Fries BE, Steel K, et al. Comprehensive clinical assessment in community setting — applicability of the MDS-HC. J Am Geriatr Soc 1997; 45: 1017–24.
Sgadari A, Morris J, Fries B, et al. Efforts to establish the reliability of the Resident Assessment Instrument. Age Ageing 1997; 26-S2: 27–30.
Carpenter GI, Teare GF, Steel K, et al. A new assessment for elders admitted to acute care: reliability of the MDS-AC. Aging Clin Exp Res 2001; 13: 316–30.
Landi F, Onder G, Tua E, et al. Impact of a new assessment system, the MDS-HC, on function and hospitalization of home bound elderly: a controlled clinical trial. J Am Geriatr Soc 2001; 49: 1288–93.
Morris JN, Carpenter GI, Berg K, Jones RN. Outcome measures for use with home care clients. Can J Aging 2000; 19 S2: 87–105.
Landi F, Lattanzio F, Gambassi G, Zuccalà G, Sgadari A, Panfilo M. A model for integrated home care of frail older patients: the Silver Network Project. Aging Clin Exp Res 1999; 12: 262–72.
Leung AC, Liu CP, Tsui LL, et al. The use of the Minimum Data Set: home care in a case management project in Hong Kong. Care Manag J 2001; 3: 8–13.
Landi F, Tua E, Onder G, et al. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care 2000; 38: 1184–90.
Morris JN. Fries BE, Morris SA. Scaling ADL’s within the MDS. J Gerontol 1999; 4: M546-53.
Morris JN, Fries BE, Mehr DR, et al. The MDS Cognitive Performance Scale. J Gerontol 1994; 49: 174–82.
Frederiksen K, Tariot P, De Jonghe E. Minimum Data Set Plus (MDS+) scores compared with scores from five rating scales. J Am Geriatr Soc 1996; 44: 305–9.
Burrows A, Morris J, Simon S, Hirdes J, Phillips C. Development of an MDS-based Depression Rating Scale for use in nursing homes. Age Ageing 2000; 29: 165–72.
Bjorkgren MA, Fries BE, Shugarman LR. A RUG-III case-mix system for home care. Can J Aging 2000; 19 S2: 106–25.
Kinnunen K. Postponing of institutional long-term care in the patients at high risk of institutionalization. Doctoral thesis. 2002.
Andersson A, Levin LA, Oberg B, Mansson L. Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke. Scand J Caring Sci 2002; 16: 386–92.
Marchionni N, Fattirolli F, Fumagalli S, et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation 2003; 107: 2201–9.
Hermiz O, Comino E, Marks G, Daffurn K, Wilson S, Harris M. Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease. BMJ 2002; 325: 938–40.
McAlister FA, Lawson FME, Teo KK, Armstrong PW. Randomised trials of secondary prevention programmes in coronary heart disease: systematic review. Am J Med 2001; 110: 378–84.
Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2003; 347: 1068–74.
Hannan EL, Magaziner JU, Wang JJ, et al. Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 2001; 285: 2736–42.
Coupland R. Effective health visiting for elderly people. Health Visitor 1986; 59: 299–300.
Stoddart H, Whitley E, Harvey I, Sharp D. What determines the use of home care services by elderly people? Health Soc Care Community 2002; 10: 348–60.
Kunkel SR, Appelbaum RA. Estimating the prevalence of long-term disability for an aging society. J Gerontol 1992; 47: S253–5.
Carpenter G, Hirdes J, Ribbe M, et al. Targeting and quality of nursing home care. A five nation study. Aging Clin Exp Res 1999; 11: 83–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Carpenter, I., Gambassi, G., Topinkova, E. et al. Community care in Europe. The Aged in HOme Care project (AdHOC). Aging Clin Exp Res 16, 259–269 (2004). https://doi.org/10.1007/BF03324550
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03324550