The Resource Long-term care for older adults : a review of home and community-based services versus institutional care, prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Andrea Wysocki [and others], (electronic resource)

Long-term care for older adults : a review of home and community-based services versus institutional care, prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Andrea Wysocki [and others], (electronic resource)

Label
Long-term care for older adults : a review of home and community-based services versus institutional care
Title
Long-term care for older adults
Title remainder
a review of home and community-based services versus institutional care
Statement of responsibility
prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Andrea Wysocki [and others]
Title variation
Effective health care program
Contributor
Subject
Genre
Language
eng
Summary
OBJECTIVES: To compare long-term care (LTC) for older adults delivered through Home and Community-Based Services (HCBS) with care provided in nursing homes (NHs) by evaluating (1) the characteristics of older adults served through HCBS and in NHs; (2) the impact of HCBS and NH care on outcome trajectories of older adults; and (3) the per person costs of HCBS and NH care, costs for other services such as acute care, and family burden. DATA SOURCES: Bibliographic databases MEDLINE(r) and AGELINE(r); grey literature in the form of program evaluation reports and reports and analyses from Web sites of relevant State and Federal agencies and research organizations; citation searches of articles; and hand searches. REVIEW METHODS: We included randomized controlled trials (RCTs) and observational studies that directly compared LTC for older adults (age 60) served through HCBS and in NHs. Studies were limited by date (1995-March 2012), language (English), and geographical location (United States and other economically developed countries with well-established health and LTC systems). Because assisted living (AL) encompasses elements of institutions, we treated it as a separate category within HCBS. We compared the characteristics of LTC recipients and the impact of the setting on outcome trajectories for physical function, cognition, mental health, mortality, use of acute care services, harms, and costs. We qualitatively synthesized results. We assessed the risk of bias and applicability of individual studies and graded the overall strength of evidence for each examined outcome. RESULTS: We identified 42 relevant studies (37 peer reviewed, 5 grey literature). We identified no RCTs. Of the 37 peer-reviewed articles, 22 evaluated recipient characteristics at a specific time, and 15 analyzed outcome trajectories over time (of which 14 were used in the longitudinal analytic set). On average, NH residents had more limitations in physical and cognitive function than both HCBS recipients and AL residents, but mental health and clinical status were mixed. The 14 studies that compared the outcome trajectories of HCBS recipients or AL residents with NH residents over time had a high risk of bias, resulting in low or insufficient evidence for all outcomes examined. In comparing AL with NH, low-strength evidence suggested no differences in outcomes for physical function, cognition, mental health, and mortality. In comparing HCBS with NHs, low-strength evidence suggested that HCBS recipients experienced higher rates of some harms while NH residents experienced higher rates of other harms. Evidence was insufficient for other outcome domains and comparisons. Evidence was also insufficient for cost comparisons. CONCLUSIONS: Determining whether and how the delivery of LTC through HCBS versus NHs affects outcome trajectories of older adults is difficult due to scant evidence and the methodological limitations of studies reviewed. More and better research is needed to draw robust conclusions about how the setting of care delivery influences the outcomes and costs of LTC for older adults
Member of
Cataloging source
ERL
Funding information
Conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ)
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
WT 27.AA1
http://library.link/vocab/relatedWorkOrContributorName
  • Wysocki, Andrea
  • Minnesota Evidence-based Practice Center
  • United States
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication,
Series volume
  • no. 81
  • no. 12(13)-EHC134-EF
http://library.link/vocab/subjectName
  • Long-Term Care
  • Aged
  • Assisted Living Facilities
  • Community Health Services
  • Comparative Effectiveness Research
  • Home Care Services
  • Nursing Homes
  • Outcome Assessment, Health Care
  • Quality of Health Care
  • Quality of Life
  • United States
  • United States
http://bibfra.me/vocab/relation/supportingbody
RzTDSdffmEM
Label
Long-term care for older adults : a review of home and community-based services versus institutional care, prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Andrea Wysocki [and others], (electronic resource)
Instantiates
Publication
Note
"November 2012."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
824190045
Extent
1 online resource (121 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)824190045
Label
Long-term care for older adults : a review of home and community-based services versus institutional care, prepared for Agency for Healthcare Research and Quality ; prepared by Minnesota Evidence-based Practice Center ; investigators, Andrea Wysocki [and others], (electronic resource)
Publication
Note
"November 2012."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
824190045
Extent
1 online resource (121 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)824190045

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