Institutional versus at-home long term care for functionally dependent older people

Abstract

BACKGROUND: An increasing number of functionally dependent older people require care and medical treatment. Increasingly governments are shifting resources into community care expecting both reduction in costs and improvement in the quality of care. However, it is difficult to establish the costs and benefits of institutional and the alternative at-home care. OBJECTIVES: To assess the effects of institutional versus at-home care for functionally dependent older people on health outcomes, satisfaction (of functionally dependent older people, relatives and health care professionals), quality of care and costs. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) specialised register (1999), the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966 to 1999), EMBASE (1980 to 1999), Best Evidence (1990 to 1999), Ageline (1982 to 1999), Cinahl (1982 to 1999), EconLit (1969 to 1999), PsycInfo (1887 to 1999), NTIS (1980 to 1999), Scisearch (1980 to 1999), Sigle (1980 to 1999), and reference lists of related systematic reviews and articles. We contacted authors working in the field in an attempt to identify unpublished studies. SELECTION CRITERIA: Randomised trials, controlled clinical trials, controlled before and after studies and interrupted time series studies where functionally dependent older people were assigned to either institutional or at-home care. DATA COLLECTION AND ANALYSIS: Three reviewers independently extracted data and assessed study quality. No meta analysis was conducted as only one trial was identified. MAIN RESULTS: One study was included involving 112 people. This evaluated a community care programme (CCP) organising foster care versus nursing home care. No studies were found where functionally dependent older people returned to their own homes. The included trial was small and of poor methodological quality. No significant difference was found between the two groups when comparing functioning (ADL and IADL), mental status, attitudes to perceived health, life satisfaction or mortality. AUTHORS' CONCLUSIONS: There is insufficient evidence to estimate the likely benefits, harms and costs of institutional or at-home care for functionally dependent older people.