Effect of a care process programme on frail older people's life satisfaction.
Helene Berglund, Susanne Gustafsson, Isabelle Ottenvall Hammar and 2 others
PMID 31367435WHAT IT FOUND
A bundled care process programme for frail older people did not improve life satisfaction during the first 6 months, but between 6 and 12 months more people maintained or improved satisfaction than with usual care.
Key findings
01There was no statistically significant difference in life satisfaction between the care programme and usual care from baseline to 3 months or from 3 to 6 months.
02From 6 to 12 months, a higher proportion of care programme participants had a positive life satisfaction outcome than usual care participants (OR 2.99, 95% CI 1.50-5.98).
03The care programme was a bundle: assessment, case manager coordination, interprofessional team, support for relatives, care-planning meetings in the home, and follow-up.
STILL TO COME
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What it does not show
The care programme group and the historical control group were collected in different periods: control data were collected between October 2008 and December 2011, and programme data between November 2012 and March 2016, so time-related changes may confound the comparison. This was not a randomised comparison in the present study; the control group came from an earlier project rather than concurrent random allocation. The power calculation was based on satisfaction with care planning, not the primary life satisfaction outcome, and required 55 people in each group for 80% power. At 12 months, 27% of programme participants and 20% of control participants had dropped out, and drop-outs had more frailty indicators at 3 and 12 months, so missing data were imputed under assumptions that may bias results. The life satisfaction measure was modified for this population: four LiSat-11 items were excluded, which may affect how consistently the shortened scale measures satisfaction. There were significantly more women in the care programme group, and the analysis did not adjust for this. The programme bundled several components, so the study cannot identify which component, if any, contributed to the later life satisfaction difference.
Declared interests
The authors declare no conflict of interest. The supplied text does not state funding.
The easy way to misread this
Do not conclude that the care process programme caused improved life satisfaction, or that any one component did. The care programme group was compared with a historical usual care group, not randomly assigned concurrent controls, and the programme included assessment, case manager coordination, an interprofessional team, support for relatives, home care-planning meetings and follow-up, so the contribution of any single component cannot be separated.