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Older people specialists needed for community care

More health professionals specialising in the care of older people are needed to prevent unnecessary admissions to nursing homes and hospitals.

Older people specialists needed for community care

That’s the implication of recent research into outcomes from the use of a geriatric screening tool that identified older people with disabilities.

Researchers assessed the effectiveness of BRIGHT (the Brief Risk Identification Geriatric Health Tool) that helps primary care providers such as general practices, to identify older people with disabilities and refer them to geriatric services if necessary, says Professor Ngaire Kerse from the University of Auckland.

BRIGHT has been used by some New Zealand primary care organisations since 2010 with the intention of reducing disability and improving outcomes among older patients. The study was a three-year randomised trial involving 8308 elderly patients from 60 primary care practices.

“The trial showed the BRIGHT screening intervention successfully identified older adults in need, and it increased residential care placement, but it did not reduce the use of acute hospital services,” says Professor Kerse.

Researchers found that primary care practices in the intervention group, who used BRIGHT, were more likely to place older people in residential care (eight versus six per cent).

Patients from those intervention groups had less of a reduction in physical and psychological health-related quality of life compared to practice patients not using the BRIGHT tool, but hospitalisation, disability and use of services did not differ between groups.

“We concluded that BRIGHT was effective in better identification of older people with disability, but there was little evidence of improved outcomes,” says Professor Kerse. She suggested a need for further research to test primary care integration strategies.

“More people in residential care is not what New Zealanders or the Government want. Our study shows there’s not enough resources in the system to forestall these admissions to nursing and rest-homes (that are funded by the Government)”, she says.

“It’s shown a need for more resources in primary care in terms of community services and a focus on integrative care to keep people in the community,” says Professor Kerse. “More gerontology care expertise, such as gerontology nurses and specialists are needed alongside general practices in the community.”

“Some district health boards, such as Waitemata DHB, have successfully piloted putting gerontology nurses alongside general practices, but many have not yet met this need”, she says. “The need will increase as our population ages.”

The study, ‘The Cluster-Randomized BRIGHT Trial: Proactive Case Finding for Community-Dwelling Older Adults’, was published this week in the top international primary health journal, Annuls of Family Medicine, based in the USA.

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