A randomised controlled trial of a care home rehabilitation service to reduce long-term institutionalisation for elderly people

• Published in: Age and ageing 2004-07, Vol.33 (4), p.384-390
• Main Authors: Fleming, Sarah A., Blake, Holly, Gladman, John R. F., Hart, Elizabeth, Lymbery, Mark, Dewey, Michael E., McCloughry, Helen, Walker, Marion, Miller, Paul
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Assisted living facilities; Care and treatment; care homes; Clinical trials; Community care; Company business management; elderly; Elderly people; England; Female; Frail elderly; Geriatric clinics; Health services; Health Services for the Aged; Home Care Services; Home health care; Humans; Institutionalization; Length of stay; Long-Term Care; Male; Management; Nottingham; Older people; Outcome Assessment (Health Care); randomised controlled trial; Randomized controlled trials; Rehabilitation; Rehabilitation Centers; Residential homes; United Kingdom
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afh126

Objectives: to evaluate the effect of a care home rehabilitation service on institutionalisation, health outcomes and service use. Design: randomised controlled trial, stratified by Barthel ADL index, social service sector and whether living alone. The intervention was a rehabilitation service based in Social Services old people's homes in Nottingham, UK. The control group received usual health and social care. Participants: 165 elderly and disabled hospitalised patients who wished to go home but were at high risk of institutionalisation (81 intervention, 84 control). Main outcome measures: institutionalisation rates, Barthel ADL index, Nottingham Extended ADL score, General Health Questionnaire (12 item version) at 3 and 12 months, Health and Social Service resource use. Results: the number of participants institutionalised was similar at 3 months (relative risk 1.04, 95% confidence intervals 0.65–1.65) and 12 months (relative risk 1.23, 95% confidence intervals 0.75–2.02). Barthel ADL Index, Nottingham Extended ADL score and General Health Questionnaire scores were similar at 3 and 12 months. The intervention group spent significantly fewer days in hospital over 3 and 12 months (mean reduction 12.1 and 27.6 days respectively, P < 0.01), but spent a mean of 36 days in a care home rehabilitation service facility. Conclusions: this service did not reduce institutionalisation, but diverted patients from the hospital to social services sector without major effects on activity levels or well-being.