Clinical Interventions in Aging (Nov 2019)
Effects Of Increasing The Involvement Of Community-Dwelling Frail Older Adults In A Proactive Assessment Service: A Pragmatic Trial
Abstract
W Rietkerk,1 DL Gerritsen,2 BJ Kollen,1 CS Hofman,3 K Wynia4,†, JPJ Slaets,5,6 SU Zuidema1 1Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 2Department of Primary and Community Care and Radboud Alzheimer Centre, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; 3Department of Innovation and Research, Vilans, Centre of Expertise on Long-Term Care, Utrecht, the Netherlands; 4Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; 5Faculty of Medical Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; 6Leyden Academy On Vitality And Ageing, Leiden, the Netherlands†K Wynia passed away on September 23, 2019Correspondence: W RietkerkDepartment of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, HPC FA21, Postbus 196, Groningen 9700 AD, the NetherlandsTel +31 6 515 38759Email [email protected]: Older adults and care professionals advocate a more integrated and proactive care approach. This can be achieved by proactive outpatient assessment services that offer comprehensive geriatric assessments to better understand the needs of older adults and deliver person-centered and preventive care. However, the effects of these services are inconsistent. Increased involvement of the older adult during the assessment service could increase the effects on older adult’s well-being.Methods: We studied the effect of an assessment service (Sage-atAge) for community-dwelling frail adults aged ≥65 years. After studying the local experiences, this service was adapted with the aim to increase participant involvement through individual goal setting and using motivational interviewing techniques by health-care professionals (Sage-atAge+). Within Sage-atAge+, when finishing the assessment, a “goal card” was written together with the older adult: a summary of the assessment, including goals and recommendations. We measured well-being with a composite endpoint consisting of health, psychological, quality of life, and social components. With regression analysis, we compared the effects of the Sage-atAge and Sage-atAge+ services on the well-being of participants.Results: In total, 453 older adults were eligible for analysis with a mean age of 77 (± 7.0) years of whom 62% were women. We found no significant difference in the change in well-being scores between the Sage-atAge+ service and the original Sage-atAge service (B, 0.037; 95% CI, −0.188 to 0.263). Also, no change in well-being scores was found even when selecting only those participants for the Sage-atAge+ group who received a goal card.Conclusion: Efforts to increase the involvement of older adults through motivational interviewing and goal setting showed no additional effect on well-being. Further research is needed to explore the relationship between increased participant involvement and well-being to further develop person-centered care for older adults.Keywords: outpatient assessment service, well-being, comprehensive geriatric assessment, motivational interviewing, goal setting, person-centered care
