Economic evaluation of a support program for caregivers of demented elderly

An economic evaluation was undertaken concurrently with a randomized trial comparing a Caregiver Support Program (CSP) with existing conventional community nursing care for those caring for elderly relatives at home. The differences in resource consumption were compared with changes in caregiver quality of life, as measured by the Caregiver Quality of Life Instrument (CQLI). A 20% difference from baseline in the CQLI favored the experimental (CSP) group, although this did not reach conventional levels of statistical significance. A comparison of improvement in quality of life with costs implies an incremental cost per quality-adjusted life year gained of Canadian $20,000 for the CSP, which compares favorably with other health care interventions. Further, larger studies are required to confirm this result.     

Needs of the family caregivers of frail elderly.

The purpose of the study was to determine the needs of family caregivers of frail elderly. Forty-one caregivers were interviewed. More than two-thirds of the caregivers were spouses and about 85% of them had health problems which affected their caregiving. Ninety-eight percent of the caregivers were living with the care recipients and the cumulative stress from their continual involvement had affected their lifestyle. Also more than 58% felt that the care recipients needed more care than they could provide. More than 68% of the caregivers were seniors. Differential planning based on each of the caregivers' needs can maximize the care they provide.     

Implementation of an innovative web-based conference table for community-dwelling frail older people, their informal caregivers and professionals: a process evaluation

ABSTRACT: BACKGROUND: Due to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved. METHODS: Mixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12). RESULTS: 290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people's exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP. CONCLUSIONS: This study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising.     

Housing for frail elderly people.

A national survey followed by an evaluation has recently been undertaken of very sheltered housing for elderly people. This enhanced sheltered housing usually provides 24-hour warden cover, meals and help with domiciliary and personal tasks. It is increasingly being provided by local authorities and housing associations. The evaluation took into account the views of management, staff, elderly people and cost. It was a successful form of housing but more expensive than staying at home with a package of care. In some cases elderly people had moved from institutional care to very sheltered housing. There were, however, people in the schemes who neither wanted nor needed to be there. There were also some problems such as doctors' unrealistic expectations of the schemes and unqualified staff being involved in medication.     

An evaluation of AIDS education: a quasi-experimental exploration.

This study reports on a quasi-experimental study designed to evaluate the relationship between receiving classroom instruction and subsequent AIDS knowledge, behavior, and attitudes. Survey information was gathered from 61 students enrolled in an AIDS course and 68 students enrolled in "control" courses. Both groups were pretested at the beginning of the semester and again at the end of the semester concerning AIDS knowledge, behavior, and attitudes. The results obtained indicated that there was a widespread acceptance of the conventional wisdom concerning AIDS in both the experimental and control groups prior to the study. Few behavior changes were observed as a result of the AIDS curriculum. Three empirically distinct factors, "interaction," "constraint," and "testing," emerged from the attitude measures. Respondents were more accepting of interacting with persons with AIDS across time. Moreover, respondents in the experimental group were more reticent to advocate mandatory AIDS testing vis-à-vis those in the control group across time.     

Promoting smoking cessation in Russian Karelia: a 1-year community-based program with quasi-experimental evaluation

Cigarette smoking is a major contributor to the East–Westhealth gap in Europe, a situation which is particularly evidentin comparisons of mortality and health behavior in Finnish andRussian Karelia. With technical assistance from the North KareliaProject in Finland, a Quit and Win smoking cessation contestwas organized in the district of Pitkäranta in RussianKarelia. Local health care workers organized media publicityand community support, including news about competition winnersand participants, and distribution of leaflets featuring storiesabout how local people were able to stop smoking during theQuit and Win contests. The Pitkäranta campaign was evaluatedin a quasi-experimental study in which panels of 176 and 202smokers, identified in a random population sample survey atthe outset, were followed for 1 year in Pitkäranta anda comparable neighboring district. Cessation rates were estimatedto be 7–26% in Pitkäranta and 1–2% in the comparisonarea, a statistically significant indication of experimentaleffects. These findings demonstrate that community campaignscan effectively reduce smoking in the present difficult conditionsin Russia.     

Supporting the elderly: workplace programs for employed caregivers.

An aging population and extended longevity are increasing the number of older people needing informal and family support. At the same time, women, the traditional caregivers, have entered the work force in record numbers. Consequently, concerns about how to care for dependent family members have become workplace issues. In response to the needs of employees who care for family members, employers have produced an array of policies, benefits, and programs, including flexible work schedules and information and referral services. Although these programs are a valuable complement to community services and government initiatives, relatively few employers have recognized the potential effects of caregiving on absenteeism, productivity, and turnover; even fewer have responded with workplace programs directed to the needs of their caregiving employees. To fill the gap, the government is considering mandating employee benefits, such as leave time for family illness. Community services are increasingly being directed to the needs of older people and their caregivers.     

An Internet-based videoconferencing system for supporting frail elderly people and their carers

The ACTION project uses information and communication technology to support frail elderly people and their family carers. The aims are to enhance their quality of life, independence and preparedness and to break social isolation. A videoconferencing system, connecting homes and a call centre, was used in a pilot study in 1997 - 2002. A re-designed system was brought into use in late 2004 and over 60 new units were introduced during the first six months. The new system was evaluated with an interview study and by data logging. Eight family users and four professional carers were interviewed. The family users had used the videophone at least six times and they had had the equipment at home for at least two months. The average number of initiated calls per user was 5.7 per month and the average call time per user was 40 min per month. Seven of the users (88%) reported that the system very much reduced their sense of loneliness and isolation. The results of the evaluation were encouraging. There were several frequent users of videoconferencing. System quality was acceptable although a shorter audio delay would be desirable. The system was used regularly by the participants and it fulfilled its purpose.     

An evaluation of a therapeutic health program for the black elderly

This paper evaluates the effectiveness of a therapeutic health program which was offered in 1988 to the black elderly living in subsidized high-rise apartments in Nashville. The pre-program data (of 1987) indicated distinct differences in that the elderly living in the high-rises had significantly more medical problems, higher levels of depression, and smaller social support networks than those living in their own single dwelling homes. The therapeutic program included various modules such as cognitive and grief therapy, reminiscence therapy, social skills and remotivation therapy. Analyses of pre-post measures of selected variables showed that the program was effective in improving the health status of the participants. As compared to a non-treatment control group, the elderly in the experimental group showed significant improvements in depression, social network, and a sense of control over their lives. A discussion of these findings is provided.     

Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation.

This paper describes a program (Community Care Program) in which some elderly hospital patients who were candidates for nursing home placement were placed in foster homes. Caregivers were carefully trained and supervised. A total of 112 elderly inpatients were randomly assigned to placement in a nursing home or a foster care home. Patients and caregivers were interviewed at 3, 6, 9, and 12 months after placement. Community Care Program patients were more likely to maintain or improve ADL (activities of daily living) and mental status scores. They also had better nursing outcomes and were more likely to get out of the house than were nursing home patients. Nursing home patients had higher life satisfaction, and participated in more social and recreational activities. The Community Care Program was 17 per cent less costly than nursing home care. The results suggest that foster care may be a viable alternative for a segment of the nursing home population.     

Design, implementation and evaluation of a health education program for the elderly

The objective was to design, implement and evaluate a health education program, using the analysis of the habits that harm the health of people over 65 years old. An evaluative research was carried out from a multiple case study in the North-West area of Spain, combining both the quantitative and the qualitative approach. A questionnaire and interview were used as tools for data collection. The elderly take a lot of medicines and also treat themselves. A small group smoke and drink alcohol. Over 25% have sedentary habits and their average body mass rate was 30.55. The implementation of the programme has significantly influenced their quality of life. Elderly people have deep rooted unhealthy habits. The achievement of educational contents improved their quality of life. However, they are reluctant to assume new habits, even though they are healthy.