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Improving Outcomes for Older People

26 September 2006

Key Findings of Research Trial to Improve Outcomes for Older People Released

The Ministry of Health says a research trial commissioned by the Ministry shows older people with high and complex needs can remain in their own homes with the right level of support.

The evaluation of services promoting independence and recovery in elders (ASPIRE evaluation) was launched in 2003 and compared the outcomes for older people with high needs against those receiving usual care through Needs Assessment Service Coordination (NASC) services.

Minister of Health Pete Hodgson has released the key findings from the ASPIRE project to aged care sector providers and district health boards at today's Health of Older People Forum.

Deputy Director General of Sector Policy Kathy Spencer says "the three randomised controlled research trials by Auckland University were Community FIRST in Hamilton, Promoting Independence Programme (PIP) in the Hutt Valley and Coordination of Services for the Elderly (COSE) in Christchurch. Overall the trial has found that all three services reduced the risk of mortality compared with usual services in these regions."

"This trial has also shown that the three services reduced the risk of entry to residential care and caregiver stress levels did not appear to rise, despite older people with high and complex needs remaining in their own homes."

Kathy Spencer says, "the Health of Older People Strategy aims to improve outcomes for older people in our community and the evaluation findings are a great start at ensuring we on the right track to do just that."

"The evaluation has shown us that such initiatives can be extremely effective in keeping older people living in the community longer", says Ms Spencer.

Next month the Ministry of Health will launch a discussion document on care and support in the community. This will provide information about the elements that worked well in the ASPIRE evaluation and how those elements could be developed into local services that will work for older people.

Background Information -

COSE Co-ordinated Services for the Elderly (COSE) was set up in 2000 by Canterbury DHB and Pegasus Health. Based in Christchurch, COSE is a community-based needs assessment and service co-ordination initiative. The aim was to avoid duplication in service provision. A key worker is assigned to several general practice teams and identifies resources and opportunity within communities. This offers older people a greater choice of service support and facilitates safely staying in the community. COSE represents an evolution of the current Needs Assessment Service Co-ordination (NASC). The model is a case management intervention.

PIP The Promoting Independence Programme (PIP) was developed by the Lower Hutt Masonic Villages Trust in collaboration with Hutt Valley District Health Board, and operates in Lower Hutt. PIP is for people who would not be able to maximise their potential for recovery within the average hospital stay. Referrals to the programme are made by medical consultants, general practitioners, NASC and other similar agencies. A key worker is assigned to each older person and they initiate and co-ordinate the person’s rehabilitation process. The process also involves a team of healthcare workers including registered nurses, occupational therapists, physiotherapists and speech therapists. Older people can receive up to 8 weeks of facility based rehabilitation or, if able to receive services in the community, up to one year of rehabilitation from the time of the health event. Hand over to home care providers occurs after that period. PIP does not replace NASC, instead it integrates with current practice. The model aims to improve functional status.

Community FIRST Community FIRST (Flexible Integrated Rehabilitation Support Team) was established in 2002 by Presbyterian Support Northern, Waikato District Health Board and the Ministry of Health, and operates in Hamilton. Community FIRST offers a different approach in the form of restorative home support, which usually involves the integration of physical activity into the routine delivery of services.

It uses a multidisciplinary team (primarily registered nurse, physiotherapist and occupational therapist) and delivery is based on several levels of support depending on the needs of the older person. It offers a replacement for current home care provision. The model aims to improve functional status.


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