Susan Wakil School of Nursing and Midwifery, The University of Sydney, 88 Mallett Street - Building M02, Camperdown, Sydney, NSW, Australia.
Sydney School of Public Health, The University of Sydney, Camperdown, Australia.
BMC Geriatr. 2019 Jul 29;19(1):199. doi: 10.1186/s12877-019-1216-x.
A major gap exists internationally in providing support to maintain functional and social independence of older people with dementia living at home. This project evaluates a model of care that integrates evidence-based strategies into a person-centred interdisciplinary rehabilitation package: Interdisciplinary Home-bAsed Reablement Program (I-HARP). Two central aims are: 1) to determine the effectiveness of I-HARP on functional independence, mobility, quality of life and depression among people with dementia, their home environmental safety, carer burden and quality of life, and I-HARP cost-effectiveness; and 2) to evaluate the processes, outcomes and influencing factors of the I-HARP implementation.
I-HARP is a 4-month model of care, integrated in community aged care services and hospital-based community geriatric services, and consists of: 1) 8-12 home visits, tailored to the individual client's needs, by an occupational therapist, registered nurse, and other allied health staff; 2) minor home modifications/assistive devices to the value of <A$1000 per participant; and 3) three individual carer support sessions. The overarching design is a mixed-methods action research approach, consisting of a multi-centre pragmatic parallel-arm randomised controlled trial (RCT) and realist evaluation, conducted in two phases. Participants include 176 dyads (person aged > 60 years with mild to moderate dementia and his/her carer). During Phase I, I-HARP advisory group is established and training of I-HARP interventionists is completed, and the effectiveness of I-HARP is examined using a pragmatic RCT. Phase II, conducted concurrently with Phase I, focuses on the process evaluation of the I-HARP implementation using a realist approach. Semi-structured interviews with participants and focus groups with I-HARP interventionists and participating site managers will provide insights into the contexts, mechanisms and outcomes of I-HARP.
I-HARP is being evaluated within the real-world systems of hospital-based and community-based aged care services in Australia. Future directions and strategies for reablement approaches to care for community dwelling people living with dementia, will be developed. The study will provide evidence to inform key stakeholders in their decision making and the use/delivery of the program, as well as influence future systems-thinking and changes for dementia care.
Australian New Zealand Clinical Trial Registry ACTR N12618000600246 (approved 18/04/2018).
在为居家患有痴呆症的老年人提供支持以维持其功能和社会独立性方面，国际上存在着重大差距。本项目评估了一种将循证策略整合到以人为中心的跨学科康复方案中的护理模式：跨学科居家康复计划（I-HARP）。两个主要目标是：1）确定 I-HARP 对痴呆症患者功能独立性、移动能力、生活质量和抑郁、家庭环境安全、照顾者负担和生活质量的影响，以及 I-HARP 的成本效益；2）评估 I-HARP 实施的过程、结果和影响因素。
I-HARP 是一种为期 4 个月的护理模式，整合在社区老年护理服务和医院社区老年服务中，包括：1）由职业治疗师、注册护士和其他辅助医疗人员进行 8-12 次家访，根据个体客户的需求进行定制；2）对参与者的家居进行轻微改造/提供价值低于 1000 澳元的辅助设备；3）三次个别照顾者支持会议。总体设计是一种混合方法的行动研究方法，包括多中心实用平行臂随机对照试验（RCT）和现实评估，分两个阶段进行。参与者包括 176 对（年龄大于 60 岁的患有轻度至中度痴呆症的人和他/她的照顾者）。在第一阶段，成立了 I-HARP 顾问小组并完成了 I-HARP 干预人员的培训，同时使用实用 RCT 检查了 I-HARP 的有效性。第二阶段与第一阶段同时进行，重点使用现实方法对 I-HARP 的实施进行过程评估。对参与者进行半结构化访谈，并对 I-HARP 干预人员和参与现场管理人员进行焦点小组讨论，以深入了解 I-HARP 的背景、机制和结果。
I-HARP 正在澳大利亚的医院和社区老年护理服务的实际系统中进行评估。未来将为居住在社区中的患有痴呆症的人制定重新康复护理方法的方向和策略。该研究将为利益相关者在决策制定以及该计划的使用/提供方面提供证据，并影响未来的系统思维和痴呆症护理的变化。
澳大利亚新西兰临床试验注册 ACTR N12618000600246（2018 年 4 月 18 日批准）。
