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How’s Your Health at Home: Frail Homebound Patients Reported Health Experience and Outcomes*

  • Margaret J. McGregor (a1) (a2) (a3), Jay Slater (a2), John Sloan (a2), Kimberlyn M. McGrail (a1) (a3) (a4), Anne Martin-Matthews (a5), Shannon Berg (a1) (a6), Alyson Plecash (a2), Leila Sloss (a2), Johanna Trimble (a2) (a7) and Janice M. Murphy (a8)...

Abstract

We used a web-based mixed methods survey (HowsYourHealth – Frail) to explore the health of frail older (78% age 80 or older) adults enrolled in a home-based primary care program in Vancouver, Canada. Sixty per cent of eligible respondents participated, representing over one quarter (92/350, 26.2%) of all individuals receiving the service. Despite high levels of co-morbidity and functional dependence, 50 per cent rated their health as good, very good, or excellent. Adjusted odds ratios for positive self-rated health were 7.50, 95 per cent CI [1.09, 51.81] and 4.85, 95 per cent CI [1.02, 22.95] for absence of bothersome symptoms and being able to talk to family or friends respectively. Narrative responses to questions about end of life and living with illness are also described. Results suggest that greater focus on symptom management, and supporting social contact, may improve frail seniors’ health.

Pour notre sondage, nous avons utilisé une méthodologie mixte basée sur le Web (How’s Your Health – Frail) pour examiner la santé des adultes fragiles (78% âgés de 80 ans et plus) inscrits à un programme de soins primaires à domicile à Vancouver, au Canada. Soixante pour cent des répondants admissibles ont participé, représentant plus d’un quart (92/350, 26,2%) de tous les individus qui reçoivent le service. Malgré des niveaux élevés de co-morbidité et de dépendance fonctionnelle, 50% ont jugé leur santé aussi bonne, très bonne ou excellente. Les ratios de cotes ajustés pour l’auto-évaluation de sa santé positive étaient de 7,50, 95 pour cent d’intervalle de confiance (IC) [1,09, 51,81] et 4,85, 95% CI [1,02, 22,95] pour l’absence de symptômes gênants et le pouvoir de parler à la famille ou amis, respectivement. Des réponses narratives aux questions sur la fin de vie et la vie avec une maladie sont également décrites. Les résultats suggèrent que l’accent mis sur la gestion des symptômes, et le soutien des contacts sociaux, peut améliorer la santé des personnes âgées fragiles.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence and requests for reprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adresées à : Margaret J. McGregor, M.D., M.H.Sc. Department of Family Practice University of British Columbia Room 713, 828 West 10th Avenue Vancouver, BC V5Z 1L8 (mrgret@mail.ubc.ca)

Footnotes

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*

We gratefully acknowledge the following individuals: John H. Wasson (creator of HowsYourHealth survey tool, Emeritus Professor of Community and Family Medicine and Medicine, Dartmouth Medical School); Megan Luk and Asheya Kushner (research assistants) who administered the HowsYourHealth – Frail survey; Michelle Cox (research analyst, UBC Dept. of Family Practice Community Geriatrics) and Lisa Ronald (Vancouver Coastal Health Research Institute Centre for Clinical Epidemiology & Evaluation) who assisted in data analysis; and the librarians of the BC College of Physicians and Surgeons Library who assisted with literature searches.

This study (2013–2014) was supported by a grant from the British Columbia College of Family Physicians and the Department of Family Practice Community Geriatrics.

Footnotes

References

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Ashida, S., & Heaney, C. A. (2008). Differential associations of social support and social connectedness with structural features of social networks and the health status of older adults. Journal of Aging and Health, 20(7), 872893. doi:10.1177/0898264308324626
Beck, R. A., Arizmendi, A., Purnell, C., Fultz, B. A., & Callahan, C. M. (2009). House calls for seniors: building and sustaining a model of care for homebound seniors. Journal of the American Geriatrics Society, 57, 11031109. doi:10.1111/j.1532-5415.2009.02278.x
Béland, F., & Hollander, M. J. (2011). Integrated models of care delivery for the frail elderly: International perspectives. Gaceta Sanitaria, 25(Suppl. 2), 138146. doi:10.1016/j.gaceta.2011.09.003
Bickel, H., Gradinger, R., Kochs, E., & Forstl, H. (2008). High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dementia and Geriatric Cognitive Disorders, 26(1), 2631. doi:10.1159/000140804
Bobak, M., Pikhart, H., Hertzman, C., Rose, R., & Marmot, M. (1998). Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey. Social Science and Medicine, 47(2), 269279.
British Columbia Ministry of Health. (2011). Patients as Partners: Nothing about me without me! First Annual Report. Retrieved from http://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/primary-health-care/patients-as-partners-annual-report-2011.pdf
British Columbia Ministry of Health. (2013). My Voice: Expressing My Wishes for Future Health Care Treatment. Advance Care Planning Guide. Retrieved from http://www.health.gov.bc.ca/library/publications/year/2013/MyVoice-AdvanceCarePlanningGuide.pdf
British Columbia Ministry of Health. (2015). Primary and Community Care in BC: A Strategic Policy Framework. Retrieved from http://www.health.gov.bc.ca/library/publications/year/2015/primary-and-community-care-policy-paper.pdf
Cacciatore, F., Abete, P., Mazzella, F., Viati, L., Della Morte, D., D’Ambrosio, D., … Rengo, F. (2005). Frailty predicts long-term mortality in elderly subjects with chronic heart failure. European Journal of Clinical Investigation, 35(12), 723730. doi:10.1111/j.1365-2362.2005.01572.x
Canadian Frailty Network. (n.d.). Frailty in Canada. Retrieved from http://www.cfn-nce.ca/frailty-in-canada/
Canadian Institute for Health Information. (2011). Health Care in Canada, 2011: A focus on seniors and aging. Ottawa, ON: Author. Retrieved from https://secure.cihi.ca/free_products/HCIC_2011_seniors_report_en.pdf
Chang, C., Jackson, S. S., Bullman, T. A., & Cobbs, E. L. (2009). Impact of a home-based primary care program in an urban Veterans Affairs medical center. Journal of the American Medical Directors Association, 10(2), 133137. doi:10.1016/j.jamda.2008.08.002
Cohen, M., & Franko, J. (2015). Living up to the promise. Vancouver, BC: Integrated Care Advocacy Group and the BC Healthcare Coalition. Retrieved from http://bchealthcoalition.ca/sites/default/files/uploads/Living%20Up%20To%20The%20Promise%20-%20Full%20Report%20-%20press%20-%20%20new%20appendixA.pdf
Collard, R. M., Boter, H., Schoevers, R. A., & Oude Voshaar, R. C. (2012). Prevalence of frailty in community-dwelling older persons: A systematic review. Journal of the American Geriatrics Society, 60(8), 14871492. doi:10.1111/j.1532-5415.2012.04054.x
Collerton, J., Davies, K., Jagger, C., Kingston, A., Bond, J., Eccles, M. P., … Kirkwood, T. B. L. (2009). Health and disease in 85 year olds: Baseline findings from the Newcastle 85+ cohort study. BMJ, 339, b4904. doi:10.1136/bmj.b4904
FNX Corporation and Trustees of Dartmouth College. (n.d.). HowsYourHealth.org . Retrieved from https://veryill.org/
1997–2016 FNX Corporation and Trustees of Dartmouth College. (n.d.). Chapter 2: Common Problems and Important Solutions. Retrieved from https://veryill.org/chapters/chapter2.html
Counsell, S. R., Callahan, C. M., Clark, D. O., Tu, W., Buttar, A. B., Stump, T. E., & Ricketts, G. D. (2007). Geriatric care management for low-income seniors: A randomized controlled trial. JAMA, 298(22), 26232633. doi:10.1001/jama.298.22.2623
Crooks, V. C., Lubben, J., Petitti, D. B., Little, D., & Chiu, V. (2008). Social network, cognitive function, and dementia incidence among elderly women. American Journal of Public Health, 98(7), 12211227. doi:10.2105/AJPH.2007.115923
De Jonge, K. E., Jamshed, N., Gilden, D., Kubisiak, J., Bruce, S. R., & Taler, G. (2014). Effects of home-based primary care on Medicare costs in high-risk elders. Journal of the American Geriatrics Society, 62(10), 18251831. doi:10.1111/jgs.12974
De Jonge, K. E., Taler, G., & Boling, P. A. (2009). Independence at home: Community-based care for older adults with severe chronic illness. Clinics in Geriatric Medicine, 25(1), 155169. doi:10.1016/j.cger.2008.11.004
Doupe, M., Kozyrskyj, A., Soodeen, R. A., Derksen, S., Burchill, C., & Huq, S. (2008). An initial analysis of emergency departments and urgent care in Winnipeg. Winnipeg, MB: Manitoba Centre for Health Policy. Retrieved from http://mchp-appserv.cpe.umanitoba.ca/reference/EDFull.pdf
Fratiglioni, L., Paillard-Borg, S., & Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. The Lancet. Neurology, 3(6), 343353. doi:10.1016/S1474-4422(04)00767-7
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., et al. (2001). Frailty in older adults: evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(3), M146M156.
Fukuse, T., Satoda, N., Hijiya, K., & Fujinaga, T. (2005). Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest, 127(3), 886891. doi:10.1378/chest.127.3.886
Garces, J. P. D., Prutsky Lopez, G. J., Wang, Z., Elraiyah, T. A., Nabhan, M., Brito Campana, J. P., … Murad, M. H. (2012). Eliciting patient perspective in patient-centered outcomes research: A meta narrative systematic review. Washington, DC: Patient-Centered Outcomes Research Institute. Retrieved from http://www.pcori.org/assets/Eliciting-Patient-Perspective-in-Patient-Centered-Outcomes-Research-A-Meta-Narrative-Systematic-Review1.pdf
Gawande, A. (2014). Being Mortal: Medicine and What Matters in the End. New York, NY: Metropolitan Books, Henry Holt.
Gillick, M. R., Serrell, N. A., & Gillick, L. S. (1982). Adverse consequences of hospitalization in the elderly. Social Science & Medicine, 16(10), 10331038.
Hoeymans, N., Feskens, E. J., Kromhout, D., & van den Bos, G. A. (1997). Ageing and the relationship between functional status and self-rated health in elderly men. Social Science & Medicine, 45(10), 15271536.
Hughes, S. L., Weaver, F. M., Giobbie-Hurder, A., Manheim, L., Henderson, W., Kubal, J. D., … Cummings, J. (2000). Effectiveness of team-managed home-based primary care: A randomized multicenter trial. JAMA, 284(22), 28772885.
Jagger, C., Collerton, J. C., Davies, K., Kingston, A., Robinson, L. A., Eccles, M. P, … Bond, J. (2011). Capability and dependency in the Newcastle 85+ cohort study. Projections of future care needs. BMC Geriatrics, 11, 21. doi:10.1186/1471-2318-11-21
Keller, D. S., Bankwitz, B., Nobel, T., & Delaney, C. P. (2014). Using frailty to predict who will fail early discharge after laparoscopic colorectal surgery with an established recovery pathway. Diseases of the Colon and Rectum, 57(3), 337342. doi:10.1097/01.dcr.0000442661.76345.f5
MacPherson, I., & McKie, L. (2010). Qualitative research in programme evaluation. In Bourgeault, I., Dingwall, R., & De Vries, R. (Eds.), The SAGE handbook on qualitative methods in health research (pp. 454478). London, ENG: Sage.
Mallery, L. H., & Moorhouse, P. (2011). Respecting frailty. Journal of Medical Ethics, 37(2), 126128. doi:10.1136/jme.2010.040147
Mendes de Leon, C. F., Glass, T. A., & Berkman, L. F. (2003). Social engagement and disability in a community population of older adults: The New Haven EPESE. American Journal of Epidemiology, 157(7), 633642. doi:10.1093/aje/kwg028
Meng, X., & D’Arcy, C. (2016). Determinants of self-rated health among Canadian seniors over time: A longitudinal population-based study. Social Indicators Research, 126(3), 13431353. doi:10.1007/s11205-015-0941-6
Merriam, S. B. (2009). Qualitative Research: A Guide to Design and Implementation. San Francisco, CA: Jossey-Bass.
Nagga, K., Dong, H. J., Marcusson, J., Skoglund, S. O., & Wressle, E. (2012). Health-related factors associated with hospitalization for old people: Comparisons of elderly aged 85 in a population cohort study. Archives of Gerontology and Geriatrics, 54(2), 391397. doi:10.1016/j.archger.2011.04.023
National Transitions of Care Coalition. (n.d.). Taking care of MY health care. Retrieved from http://www.ntocc.org/Portals/0/PDF/Resources/Taking_Care_of_My_Health_Care.pdf
Nelson, E. C., Eftimovska, E., Lind, C., Hager, A., Wasson, J. H., & Lindblad, S. (2015). Patient reported outcome measures in practice. BMJ, 350, g7818. doi:10.1136/bmj.g7818
Nelson, E. C., Landgraf, J. M., Hays, R. D., Wasson, J. H., & Kirk, J. W. (1990). The functional status of patients: How can it be measured in physicians’ offices? Medical Care, 28(12), 11111126.
Okura, Y., Urban, L. H., Mahoney, D. W., Jacobsen, S. J., & Rodeheffer, R. J. (2004). Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. Journal of Clinical Epidemiology, 57(10), 10961103. doi:10.1016/j.jclinepi.2004.04.005
Ontario Ministry of Health and Long-Term Care. (2012). Ontario’s action plan for health care: Better patient care through better value from our health care dollars. Toronto, ON: Government of Ontario. Retrieved from http://www.health.gov.on.ca/en/ms/ecfa/healthy_change/docs/rep_healthychange.pdf
Ornstein, K. A., Leff, B., Covinsky, K. E., Ritchie, C. S., Federman, A. D., , Roberts L., … Szanton, S. L. (2015). Epidemiology of the Homebound Population in the United States. JAMA 175(7), 11801186. doi:10.1001/jamainternmed.2015.1849
Ornstein, K., Hernandez, C. R., DeCherrie, L. V., & Soriano, T. A. (2011). The Mount Sinai (New York) Visiting Doctors Program: Meeting the needs of the urban homebound population. Care Management Journals, 12(4), 159163. doi:10.1891/1521-0987.12.4.159
Perruccio, A. V., Katz, J. N., & Losina, E. (2012). Health burden in chronic disease: Multimorbidity is associated with self-rated health more than medical comorbidity alone. Journal of Clinical Epidemiology, 65(1), 100106. doi:10.1016/j.jclinepi.2011.04.013
Rockwood, K., Song, X., MacKnight, C., Bergman, H., Hogan, D. B., McDowell, I., & Mitnitski, A. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489495. doi:10.1503/cmaj.050051
Rosenberg, T., & Slater, J. (2009). A home care practice that works. Retrieved from http://www.slideshare.net/BCAGCP/a-home-care-practice-that-works-for-syllabus
Rosenberg, T. (2012). Acute hospital use, nursing home placement, and mortality in a frail community-dwelling cohort managed with Primary Integrated Interdisciplinary Elder Care at Home. Journal of the American Geriatrics Society, 60(7), 13401346. doi:10.1111/j.1532-5415.2012.03965.x
Simpson, C. F., Boyd, C. M., Carlson, M. C., Griswold, M. E., Guralnik, J. M., & Fried, L. P. (2004). Agreement between self-report of disease diagnoses and medical record validation in disabled older women: Factors that modify agreement. Journal of the American Geriatrics Society, 52(1), 123127. doi:10.1111/j.1532-5415.2004.52021.x
Sloan, J. (2009). A bitter pill–How the medical system is failing the frail elderly. Vancouver, BC: Greystone Books.
Themessl-Huber, M., Hubbard, G., & Munro, P. (2007), Frail older people’s experiences and use of health and social care services. Journal of Nursing Management, 15(2), 222229. doi:10.1111/j.1365-2834.2007.00726.x
Victor, C. R., & Bowling, A. (2012). A longitudinal analysis of loneliness among older people in Great Britain. The Journal of Psychology, 146(3), 313331. doi:10.1080/00223980.2011.609572
Wajnberg, A., Wang, K. H., Aniff, M., & Kunins, H. V. (2010). Hospitalizations and skilled nursing facility admissions before and after the implementation of a home-based primary care program. Journal of the American Geriatrics Society, 58(6), 11441147. doi:10.1111/j.1532-5415.2010.02859.x
Wasson, J. H., Forsberg, H. H., Lindblad, S., Mazowita, G., McQuillen, K., & Nelson, E. C. (2012). The medium is the (health) measure: Patient engagement using personal technologies. Journal of Ambulatory Care Management, 35(2), 109117. doi:10.1097/JAC.0b013e31824a235e
Zunzunegui, M. V., Kone, A., Johri, M., Beland, F., Wolfson, C., & Bergman, H. (2004). Social networks and self-rated health in two French-speaking Canadian community dwelling populations over 65. Social Science & Medicine, 58(10), 20692081. doi:10.1016/j.socscimed.2003.08.005
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Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
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