title: Promoting independence in frail older people: a randomised controlled trial of a restorative care service in New Zealand.
abstract: BACKGROUND
  frail older people often require tailored rehabilitation in order to remain at home, especially following a period of hospitalisation. Restorative care services aim to enhance an older person's ability to remain improve physical functioning, either at home or in residential care but evidence of their effectiveness is limited.
  
  
  OBJECTIVE
  to evaluate the effectiveness of a restorative care service on institutional-free survival and health outcomes in frail older people referred for needs assessment in New Zealand.
  
  
  METHODS
  a randomised controlled trial of restorative care or usual care in 105 older people at risk of permanent residential who were follow-up over 24 months. The restorative care service was delivered in short-stay residential care facilities and at participants' residences with the aim of reducing the requirement for permanent residential care. It included a comprehensive geriatric assessment and care plan developed and delivered, initially by a multi-disciplinary team and subsequently by home care assistants.
  
  
  RESULTS
  compared with usual care, there was a non-significant absolute risk reduction of 14.3% for death or permanent residential care (8.8% for residential care and 7.2% for death alone) for the restorative care approach. There was no difference in levels of burden among caregivers.
  
  
  CONCLUSIONS
  restorative care models that utilise case management and multi-disciplinary care may positively impact on institutional-free survival for frail older people without adversely impacting on the health of caregivers.
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, 11 Salisbury Road, Ipswich, QLD 4305, Australia.
authors.forename: Hugh E J
authors.initials: HE
authors.lastname: Senior
authors.forename: Matthew
authors.initials: M
authors.lastname: Parsons
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Chen
authors.forename: Stephen
authors.initials: S
authors.lastname: Jacobs
authors.forename: Stephen Vander
authors.initials: SV
authors.lastname: Hoorn
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006299:Health Services for the Aged; D006699:Home Care Services; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D008297:Male; D009520:New Zealand; D010351:Patient Discharge / Q000592:standards; D015397:Program Evaluation; D012046:Rehabilitation / Q000379:methods / Q000706:statistics & numerical data; D012112:Residential Facilities / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: case management; frailty; institutionalisation; older people; restorative care