Post-hospital support program for the frail elderly and their caregivers: A quasi-experimental evaluation

Citation Oktay, J. S., & Volland, P. J. (1990). Post-hospital support program for the frail elderly and their caregivers: A quasi-experimental evaluation. American Journal of Public Health, 80 (1), 39-46.

Design Quasi - experiment

Purpose The purpose of this study was to evaluate the effectiveness of a support program for caregivers of the frail elderly following hospital discharge.

Hypothesis The Post-Hospital Support Program will reduce caregiver stress, improve functioning and reduce mortality and health service utilization in patients.

Participants The participants were N=191 pairs of patients at the Johns Hopkins Hospital and their caregivers.

Outcome / Dependent Variables Caregiver stress, patient functioning and mortality, and health service utilization.

Procedure The Post-Hospital Support Program provided both medical and social services to the frail elderly and their families for one year following hospitalization. A coordinated approach was provided by a project team made up of a nurse and a social worker. Services included assessment, case management, skilled nursing, counseling, referrals, respite, education, support group, medical back-up, and on-call help. All cases received a minimum of one nurse and one social work visit per month. However, the amount of service depended on need. The service differed from what is usually available in the Baltimore area not only in the amount of service, but also in its coordinated medical-social approach: Focus was on the caregiver/patient configuration and not primarily on the patient; the service was closely coordinated with the hospital inpatient and outpatient services; and service extended for one year post-discharge, regardless of the health status of the patient. Additional services were available, such as respite, some "gap filling" money (used primarily for incontinence supplies), and a support group. Interviews were conducted with patients and caregivers at 1, 2, 3, 6 9, and 12 months after discharge.

Outcomes Results showed a slight reduction in caregiver stress and a substantial reduction in hospital days used by the treatment group (an average difference of 6.5 days per patient). The data also suggest that the treatment program may have postponed some deaths and nursing home placements. The results suggest that support services for the frail elderly and their caregivers can be cost efficient by reducing hospital length-of-stay. Savings were estimated at $4,585 per patient per year in this study.

Author Oktay, J. S., & Volland, P. J.