Case management, preventive strategies, and caregiver attitudes among older adults in home care: Results of the ADHOC study

Background: Among older adults, integration of health services in a continuum of care with case management programs was shown to reduce progression of functional decline, hospitalization, and institutionalization. We hypothesized that such an approach may also result in a higher rate of use of preventive strategies and lower caregiver distress. Methods: Data were from the baseline assessment of the AgeD in Home Care project, a study enrolling subjects aged 65 years or older receiving home care in Europe. Preventive strategies considered were: (1) blood pressure measured in the last 2 years; (2) influenza vaccination in the last 2 years; (3) medication reviewed in the last 180 days. Results: Mean age of participants was 82.3 years and 2971 (74%) were women; 1539 (38%) received home care program based on case management. Overall, 1350 (88%) of 1539 participants in the case manager group and 2046 (83%) of 2468 of those in the no case manager group had blood pressure measured in the last 2 years (P <.001). After adjusting for potential confounders, this result was still statistically significant (OR 1.31, 95% CI: 1.08-1.59). Similarly, more participants in the case manager groups received influenza vaccination (1083/1539 [70%] versus 1293/2468 [52%], P <.001) and had medication reviewed (312/1539 [20%] versus 356/2468 [15%], P <.001) compared with those in the no case manager group and these associations were confirmed after adjusting for confounders (OR: vaccination 2.08, 95% CI: 1.81-2.39; medication review 1.69, 95% CI 1.42-2.01). Furthermore, the caregivers of subjects in case manager group were less likely to be unable to continue in caring activities (49/1320 [4%] versus 134/2129 [6%], P =.01) and less dissatisfied (28/1320 [2%] versus 83/1129 [4%], P <.001) compared with those in the no case manager group. Conclusions: Home care services based on case management approach result in a higher rate of use of preventive strategies and lower burden for caregivers.