The Assessment of Services Promoting Independence and Recovery in Elders Trial (ASPIRE): a pre-planned meta-analysis of three independent randomised controlled trial evaluations of ageing in place initiatives in New Zealand.
BACKGROUND
intermediate care has been developed to support older people to remain living in their own homes, combining a higher level of support with a rehabilitation focus. Evidence around their effectiveness remains mixed and there is ambiguity around the components.


OBJECTIVE
to establish the impact of intermediate care on institutional free survival in frail older people referred for needs assessment in New Zealand (NZ).


METHODS
pre-planned meta-analysis of three randomised controlled trials with follow-up at 3, 6, 12, 18 and 24 months. A total of 567 older people at risk of permanent institutionalisation as well as their primary informal carer (n = 234) were randomised to either intermediate or usual care. Interventions had common key features of care management, though varied in the use of ongoing care provision.


RESULTS
the adjusted hazard ratio for the combined primary outcome of death or residential entry was 31% lower with a 95% confidence interval of (9%, 47%) for the intermediate care initiatives compared with usual care.


CONCLUSIONS
intermediate care utilising a care management approach reduces a frail older person's risk of mortality and permanent institutionalisation.
Faculty of Medical and Health Sciences, The University of Auckland & Older Person Rehabilitation, Wakato District Health Board, Auckland, New Zealand. m.parsons@auckland.ac.nz
Matthew
M
Parsons
Hugh E J
HE
Senior
Ngaire
N
Kerse
Mei-Hua
MH
Chen
Stephen
S
Jacobs
Stephen
S
Vanderhoorn
Paul M
PM
Brown
Craig
C
Anderson
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D007326:Institutionalization / Q000592:standards; D007380:Intermediate Care Facilities / Q000592:standards*; D008297:Male; D009026:Mortality / Q000639:trends; D009520:New Zealand; D009735:Nursing Homes / Q000592:standards; D017063:Outcome Assessment, Health Care / Q000592:standards*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic