The effect of community nurse on mortality and hospitalization in a group of over-75 older adults: a nested case-control study
Keywords:
Community Nurse, Functional Geriatric Evaluation, Hospitalization, Mortality, Frail Older Adults, Pro-Active CareAbstract
Background. Bio-psycho-social frailty can negatively affect the health status of an ageing population. The integration between community nurses and social services can emphasize community care and prevent the onset of both health and social negative outcomes in the older population. The aim of the paper is to explore the causal association through the analysis of the hospitalization and mortality rate after a pro-active social service integrated by the community nurse.
Study Design. A nested case-control study comparing groups of older adults has been carried out. Methods. The paper compares data stem from a cohort followed up by the University of Rome “Tor Vergata” with data from the “Long Live the Elderly!” program (LLE) cohort.
Results. One-year standardized mortality rate was 6.5%, 4.7% and 7.5% in the control group, the LLE group and the LLE group integrated by the community nurse (LLE-CN), respectively. One-year hospitalization rate was 15.4%, 15.5% and 10.8% in the control group, the LLE group and the LLE-CN group, respectively. Conclusions. According to our results a social service with a pro-active approach, integrated by the community nurse, appears to be able to reduce mortality and hospitalization in a group of older adults aged>75. The multidimensional assessment of frailty stands for the first step of a new organization of community services.
References
1. Eurostat. Household Composition Statistics, 2019. Available on: https://ec.europa.eu/eurostat/statisticsexplained/ [Last accessed: 2020, Oct 5].
2. Bone AE, Morgan M, Maddocks M, et al. Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders. Age Ageing 2016; 45(6): 863-73. doi:10.1093/ ageing/afw124.
3. Pellizzari M. L’infermiere Di Comunità - Dalla Teoria Alla Prassi. McGraw-Hill Education, 2008.
4. Murray CJL, Vos T, Lozano R, et al. Disabilityadjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2197-223. doi: 10.1016/S0140-6736(12)61689-4.
5. Liotta G, Inzerilli MC, Palombi L, et al. Social Interventions to Prevent Heat-Related Mortality in the Older Adult in Rome, Italy: A Quasi-Experimental Study. Int J Environ Res Public Health 2018; 15(4): 715. doi: 10.3390/ijerph15040715.
6. Liotta G, Marazzi MC, Orlando S, Palombi L. Is social connectedness a risk factor for the spreading of COVID-19 among older adults? The Italian paradox. PLoS One 2020; 15(5): e0233329. eCollection 2020. doi: 10.1371/ journal.pone.02333.29
7. Palombi L, Liotta G, Orlando S, Emberti Gialloreti L, Marazzi MC. Does the Coronavirus (COVID-19) Pandemic Call for a New Model of Older People Care? Front Public Health 2020; 8. doi: 10.3389/fpubh.2020.00311.
8. Horrocks S, Pollard K, Duncan L, et al. Measuring quality in community nursing: a mixedmethods study. Health Serv Deliv Res 2018; 6(18): 1-132. doi:10.3310/hsdr06180.
9. Liotta G, Ussai S, Illario M, et al. Frailty as the Future Core Business of Public Health: Report of the Activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Int J Environ Res Public Health 2018; 15(12). doi:10.3390/ ijerph15122843.
10. Yu R, Tong C, Woo J. Effect of an integrated care model for pre-frail and frail older people living in community. Age Ageing June 2020. doi:10.1093/ageing/afaa087.
11. Ganann R, Weeres A, Lam A, Chung H, Valaitis R. Optimization of home care nurses in Canada: A scoping review. Heal Soc Care Community 2019; 27(5): e604-e621. doi:10.1111/ hsc.12797.
12. Garrard JW, Cox NJ, Dodds RM, Roberts HC, Sayer AA. Comprehensive geriatric assessment in primary care: a systematic review. Aging Clin Exp Res 2019; 32(2): 197-205. doi:10.1007/ s40520-019-01183-w.
13. Vaartio-Rajalin H, Fagerström L. Professional care at home: Patient-centredness, interprofessionality and effectivity? A scoping review. Health Soc Care Community 2019; 27(4): e270e288. doi:10.1111/hsc.12731.
14. Shea S, Weinstock RS, Teresi JA, et al. A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study. J Am Med Informatics Assoc 2009; 16(4): 446-56. doi:10.1197/jamia. M3157.
15. Rudd P, Houstonmiller N, Kaufman J, et al. Nurse management for hypertension. A systems approach. Am J Hypertens 2004; 17(10): 921-7. doi:10.1016/j.amjhyper.2004.06.006.
16. Taylor CB, Miller NH, Reilly KR, et al. Evaluation of a nurse-care management system to improve outcomes in patients with complicated diabetes. Diabetes Care 2003; 26(4): 1058-63. doi:10.2337/diacare.26.4.1058.
17. Walters J, Cameron-Tucker H, Wills K, et al. Effects of telephone health mentoring in community-recruited chronic obstructive pulmonary disease on self-management capacity, quality of life and psychological morbidity: A randomised controlled trial. BMJ Open 2013; 3(9). doi:10.1136/bmjopen-2013-003097.
18. Massimi A, De Vito C, Brufola I, et al. Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and metaanalysis. PLoS One 2017; 12(3): e0173617. doi:10.1371/journal.pone.0173617.
19. Becqué YN, Rietjens JAC, van Driel AG, van der Heide A, Witkamp E. Nursing interventions to support family caregivers in end-of-life care at home: A systematic narrative review. Int J Nurs Stud 2019; 97: 28-39. doi:10.1016/j. ijnurstu.2019.04.011.
20. Bischoff EWMA, Akkermans R, Bourbeau J, Van Weel C, Vercoulen JH, Schermer TRJ. Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: Randomised controlled trial. BMJ 2012; 345(7885). doi:10.1136/bmj.e7642.
21. Cramm JM, Nieboer AP. Self-management abilities and quality of life among frail community-dwelling individuals: the role of community nurses in the Netherlands. Health Soc Care Community 2017; 25(2): 394-401. doi:10.1111/ hsc.12318.
22. Ofori-Asenso R, Chin KL, Sahle BW, Mazidi M, Zullo AR, Liew D. Frailty confers high mortality risk across different populations: Evidence from an overview of systematic reviews and meta-analyses. Geriatrics 2020; 5(1): 1-2. doi:10.3390/GERIATRICS5010017.
23. Coelho T, Paúl C, Gobbens RJJ, Fernandes L. Frailty as a predictor of short-term adverse outcomes. PeerJ 2015; 3: e1121. doi:10.7717/ peerj.1121.
24. Wen YC, Chen LK, Hsiao FY. Predicting mortality and hospitalization of older adults by the multimorbidity frailty index. PLoS One 2017; 12(11). doi:10.1371/journal.pone.0187825.
25. Muszalik M, Gurtowski M, Doroszkiewicz H, Gobbens RJJ, Kędziora-Kornatowska K. Assessment of the relationship between frailty syndrome and the nutritional status of older patients. Clin Interv Aging 2019; 14: 773-80.
doi:10.2147/CIA.S201835.
26. Deschodt M, Laurent G, Cornelissen L, et al. Core components and impact of nurse-led integrated care models for home-dwelling older people: A systematic review and meta-analysis. Int J Nurs Stud 2020; 105: 103552. doi:10.1016/j. ijnurstu.2020.103552.
27. Von Elm E, Altman DG, Egger M, et al. STROBE Statement: Linee Guida per descrivere gli studi osservazionali. Trad Ital. Terapia Evidence Based 2008; 1(1).
28. Liotta G, O’Caoimh R, Gilardi F, et al. Assessment of frailty in community-dwelling older adults residents in the Lazio region (Italy): A model to plan regional community-based services. Arch Gerontol Geriatr 2017; 68: 1-7. doi:10.1016/j.archger.2016.08.004.
29. Liotta G, Gilardi F, Orlando S, et al. Cost of hospital care for the older adults according to their level of frailty. A cohort study in the Lazio region, Italy. PLoS One 2019; 14(6): e0217829. doi:10.1371/journal.pone.0217829.
30. Capanna A, Scarcella P, Gilardi F, et al. Sensitivity and Specificity of a Short Questionnaire to Screen Frailty in the Community-Dwelling Older Population. Adv Aging Res 2018; 07(03): 52-63. doi:10.4236/aar.2018.73005.
31. Palombi L, Liotta G, Scarcella P, Gilardi F, eds. Rapporto La valutazione del grado di fragilità e del fabbisogno di assistenza continuativa degli ultrasessantaquattrenni nel Lazio. Available on: https://biomedicinaeprevenzione.uniroma2.it/ uploads/9/3/7/9/93798184/report_screening_ fragilità.pdf. Published 2015 [Last accessed: 2020, Oct 5].
32. Grauer H, Birnbom F. A geriatric functional rating scale to determine the need for institutional care. J Am Geriatr Soc 1975; 23(10): 472-6.
doi:10.1111/j.1532-5415.1975.tb00933.x.
33. Scarcella P, Liotta G, Marazzi MC, Carbini R, Palombi L. Analysis of survival in a sample of elderly patients from Ragusa, Italy on the basis of a primary care level multidimensional evaluation. Arch Gerontol Geriatr 2005; 40(2): 147-56. doi:10.1016/j.archger.2004.07.004.
34. Centers for Disease Control and Prevention (CDC). Check for Safety a Home Prevention Checklist for Older Adults. 2005. Available on: https://www. cdc.gov/steadi/pdf/check_for_safety_brochure-a. pdf [Last accessed: 2020, Oct 5].
35. Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its history and challenges. J Nutr Health Aging 2006; 10(6): 456-63.
36. Guigoz Y. The Mini Nutritional Assessment (MNA®) review of the literature - What does it tell us? J Nutr Health Aging 2006; 10(6): 466-85.
37. Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mininutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56(6): M366-72. doi:10.1093/gerona/56.6.m366.
38. Pharmaceutical Care Network Europe. DRPRegistration Form V6.2 (PCNE Classification), 2010.
39. Hamar B, Wells A, Gandy W, et al. The impact of a proactive chronic care management program
on hospital admission rates in a German health insurance society. Popul Health Manag 2010; 13(6): 339-45. doi:10.1089/pop.2010.0032.
40. Delaney C, Apostolidis B. Pilot testing of a multicomponent home care intervention for older adults with heart failure: an academic clinical partnership. J Cardiovasc Nurs 2010; 25(5): E27-40. doi:10.1097/JCN.0b013e3181da2f79.
41. Huggins CM, Phillips CY. Using case management with clinical plans to improve patient outcomes. Home Healthc Nurse 1998; 16(1): 15-20.
42. Moore JAM. Evaluation of the efficacy of a nurse practitioner-led home-based congestive heart failure clinical pathway. Home Health Care Serv Q 2016; 35(1): 39-51. doi:10.1080/01621424.2 016.1175992.
43. Rondinini L, Coceani M, Borelli G, et al. Survival and hospitalization in a nurse-led domiciliary intervention for elderly heart failure patients. J Cardiovasc Med (Hagerstown) 2008; 9(5): 470-5. doi:10.2459/JCM.0b013e3282f19350.
44. Young W, Rewa G, Goodman SG, et al. Evaluation of a community-based inner-city disease management program for postmyocardial infarction patients: A randomized controlled trial. CMAJ 2003; 169(9): 905-10.
45. Aguado O, Morcillo C, Delàs J, et al. Long-term implications of a single home-based educational intervention in patients with heart failure. Heart Lung 2010; 39(6 Suppl): S14-22. doi:10.1016/j.
hrtlng.2010.04.010.
46. Schubert CC, Myers LJ, Allen K, Counsell SR. Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed. J Am Geriatr Soc 2016; 64(7): 1503-9. doi:10.1111/jgs.14179.
47. Delaney EK, Murchie P, Lee AJ, Ritchie LD, Campbell NC. Secondary prevention clinics for coronary heart disease: a 10-year follow-up of a randomised controlled trial in primary care. Heart 2008; 94(11): 1419-23. doi:10.1136/ hrt.2007.126144.
48. Murchie P, Campbell NC, Ritchie LD, Simpson JA, Thain J. Secondary prevention clinics for coronary heart disease: Four year follow up of a randomised controlled trial in primary care. BMJ 2003; 326(7380): 84-7. doi:10.1136/ bmj.326.7380.84.
49. Galbreath AD, Krasuski RA, Smith B, et al. Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation 2004; 110(23): 3518-26.
50. Sisk JE, Hebert PL, Horowitz CR, McLaughlin MA, Wang JJ, Chassin MR. Effects of nurse management on the quality of heart failure care in minority communities: A randomized trial. Ann Intern Med 2006; 145(4): 273-83. doi:10.7326/00034819-145-4-200608150-00007.
51. Muntean A, Tomita M, Ungureanu R. The Role of the Community Nurse in Promoting Health and Human Diginity. Iran J Public Health 2013; 42(10): 1077-84.
52. Rostgaard T, Szebehely M. Changing policies, changing patterns of care: Danish and Swedish home care at the crossroads. Eur J Ageing 2012; 9(2): 101-9. doi:10.1007/s10433-011-0209-1.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.