Home and Community Care Digest
Methods: Eligible participants had to be 65 years or older, living in Sacramento, CA, owners of a public employee long-term care insurance plan (CalPERS), and suffering from one or more qualifying chronic conditions (e.g. diabetes, arthritis, cardiovascular disease). Of the 1,650 individuals meeting these criteria, 507 agreed to participate in the study and were randomized to receive the intervention (255) or usual care (249). The intervention lasted 12 months, and consisted of a client-developed health action plan, health coaching by a registered nurse, social worker consultation and counselling, a fitness program, and referrals to community programs. Clients could arrange meetings or consultations with their nurse health coach at any time during the intervention. All clients completed self-assessment questionnaires before and after the 12-month study, reporting on chronic health conditions, amount of aerobic exercise in the past week, and social activities in the past month.
Findings: The majority (55%) of the intervention group chose exercise as their health action plan focus. Other priorities included chronic condition management (21%), weight loss (12%), improved nutrition (9%), and dealing with depression (5%) (14% chose more than one focus). The intervention group received an average of 11 hours of nurse coaching during the year. Only 30% of the intervention group attended the program's health education classes, and of these 40% attended only one class. Participation in fitness classes was somewhat better at 45%, with an average participation duration of 8 months.
After the 12-month intervention, aerobic and stretching activity per week had increased by 42 minutes versus a decrease of 18 minutes in the control group. While changes to body mass index, depression, and health care utilization were not significantly different between intervention and control groups, there were some significant differences among specific subgroups. For example, among individuals with clinical depression at the beginning of the study, the intervention group showed significant improvement compared to the control group. Similarly, communication with physicians improved (i.e. more questions during consultations) among those with two or more chronic conditions, and body mass index improved significantly among those with a university education and among males. Contrary to previous results, there was no significant reduction in ER visits or hospital inpatient admissions in the intervention group.
Conclusions: This trial of a seniors' wellness program has several potential implications for policymakers looking to implement similar programs in their jurisdictions. One-to-one coaching, consultation on individualized health plans, and fitness classes are well used, but awareness classes and printed materials are not. Interventions may need to be targeted; for example social counselling could be targeted to individuals already suffering from depression, and health awareness interventions to individuals with multiple chronic conditions. And finally, any anticipated reductions in health care utilization as a result of the intervention may take longer than 12 months to materialize.
Reference: Holland SK, Greenberg J, Tidwell L, Malone J, Mullan J, Newcomer R. "Community-Based Health Coaching, Exercise, and Health Service Utilization". Journal of Aging and Health, December 2005; 17(6,) 697-716.
Be the first to comment on this!
Personal Subscriber? Sign In
Note: Please enter a display name. Your email address will not be publically displayed