Centre for Research on Ageing, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.
Health Soc Care Community. 2013 Jan;21(1):69-78. doi: 10.1111/j.1365-2524.2012.01088.x. Epub 2012 Sep 25.
A randomised controlled trial was conducted to test the effectiveness of the Home Independence Program (HIP), a restorative home-care programme for older adults, in reducing the need for ongoing services. Between June 2005 and August 2007, 750 older adults referred to a home-care service for assistance with their personal care participated in the study and received HIP or 'usual' home-care services. Service outcomes were compared at 3 and 12 months. Subgroups of 150 from each group were also compared on functional and quality of life measures. Data were analysed by 'intention-to-treat' and 'as-treated'. The intention-to-treat analysis showed at 3 and 12 months that the HIP group was significantly less likely to need ongoing personal care [Odds ratio (OR) = 0.18, 95% CI = 0.13-0.26, P < 0.001; OR = 0.22, 95% CI = 0.15-0.32, P < 0.001]. Both subgroups showed improvements on the individual outcome measures over time with the only significant differences being found at 12 months for Instrumental Activities of Daily Living (IADL) in the as-treated analysis. Contamination of the control group by an increased emphasis on independence across the home-care agency involved, together with other methodological problems encountered, is thought to account for the few differences between groups in individual outcomes. Despite no difference between the groups over time in their overall ADL scores, a significantly smaller proportion of the HIP group required assistance with bathing/showering, the most common reason for referral, at 3 and 12 months. The results support earlier findings that participating in a short-term restorative programme appears to reduce the need for ongoing home care. The implementation of such programmes more broadly throughout Australia could substantially offset the projected increase in demand for home care associated with the five-fold projected increase in numbers of the oldest old expected over the next 40 years.
一项随机对照试验旨在测试家庭独立计划（HIP）的有效性，这是一项针对老年人的康复家庭护理计划，旨在减少对持续服务的需求。在 2005 年 6 月至 2007 年 8 月期间，750 名被转介到家庭护理服务以帮助其个人护理的老年人参与了这项研究，并接受了 HIP 或“常规”家庭护理服务。在 3 个月和 12 个月时比较了服务结果。每个组的 150 个亚组还比较了功能和生活质量措施。数据通过“意向治疗”和“实际治疗”进行分析。意向治疗分析表明，在 3 个月和 12 个月时，HIP 组需要持续个人护理的可能性显著降低[优势比（OR）=0.18，95%置信区间（CI）=0.13-0.26，P<0.001；OR=0.22，95%CI=0.15-0.32，P<0.001]。两个亚组随着时间的推移在个别结果测量上都有所改善，只有在实际治疗分析中，在 12 个月时发现日常生活活动（IADL）的工具性活动方面有显著差异。据认为，由于所涉及的家庭护理机构更加注重独立性，以及遇到的其他方法学问题，对照组受到了污染，这导致了各个组之间在个别结果方面的差异很小。尽管在日常生活活动的总体评分方面，两组之间没有随时间的变化而有所不同，但在 3 个月和 12 个月时，HIP 组需要洗澡/淋浴帮助的比例明显较小，这是转介的最常见原因。研究结果支持了早期的发现，即参与短期康复计划似乎可以减少对持续家庭护理的需求。在澳大利亚更广泛地实施此类计划可以大大抵消与未来 40 年内预计增加 5 倍的最年长人群数量相关的对家庭护理需求的预期增加。
