Effects of an integrated neighborhood approach on older people's (health-related) quality of life and well-being

Abstract

Background: Integrated neighborhood approaches (INAs) are increasingly advocated to reinforce formal and informal community networks and support community-dwelling older people. They aim to augment older people's self-management abilities and engage informal networks before seeking professional support. INAs' effectiveness however remains unknown. We evaluated an INA's effects on older people's (health-related) quality of life (HRQoL) and well-being in Rotterdam. Methods: We used a matched quasi-experimental design comparing INA with "usual" care and support. Community-dwelling frail older (70+ years) people and frailty- and gender-matched control subjects (n = 186 each) were followed over a 1-year period (measurements at baseline and 6 and 12 months). Primary outcomes were HRQoL (EQ-5D-3L, SF-20) and well-being [social production function instrument for the level of well-being (SPF-IL)]. The effect of INA was analysed using an "intention to treat" and an "as treated" approach. Results: The results indicated that pre-intervention participants had lower incomes and were significantly older, more often single, less educated and more likely to have ≥1 disease than control subjects; they had lower well-being, physical functioning, role functioning, and mental health. Generalized linear mixed modelling of repeated measurements revealed no substantial difference in well-being or HRQoL between the intervention and control group after 1 year. The small differences we did find in the intention to treat group though were in favour of the control subjects (SF-20 = 6.98, 95 % confidence interval [CI] = 2.45-11.52; SPF-IL =.09, 95 % CI =.01-.17). However, the difference in well-being (SPF-IL) disappeared in the as treated analysis. Conclusions: The lack of effects of INA highlights the complexity of integrated care and support initiatives. Barriers associated with meeting the complex, varied needs of frail older people, and those related to dynamic political and social climates challenge initiative effectiveness. Trial registration The research was supported with a grant provided by the Netherlands Organisation for Health Research and Development (ZonMw, project number 314030201) as part of the National Care for the Elderly Programme.