Personal assistance for older adults (65+) without dementia: Cochrane systematic review
Assessed as up to date: 2005/06/14
There is a high prevalence of impairments among people 65+, and the elderly population is increasing in the West. Many countries offer personal assistance, individualised support for people living in the community by a paid assistant other than a healthcare professional for at least 20 hours per week.Objectives
To assess the effectiveness of personal assistance for older adults with impairments, and the impacts of personal assistance on others, compared to other interventions.Search strategy
Electronic databases including CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Dissertation Abstracts International and a variety of specialist Swedish databases were searched from 1980 to June 2005; reference lists were checked; 345 experts, organisations, government bodies and charities were contacted in an attempt to locate relevant research.Selection criteria
This review included older adults (65+) living in the community who require assistance to perform tasks of daily living (e.g., bathing and eating) and participate in normal activities due to permanent impairments. Controlled studies of personal assistance in which participants were prospectively assigned to study groups and in which control group outcomes were measured concurrently with intervention group outcomes were included.Data collection and analysis
Titles and abstracts were examined by two reviewers. Outcomes data were extracted. Because they made different comparisons, studies were not combined for meta-analyses. Studies were assessed for the possibility of bias. Results and potential sources of bias are presented for included studies.Main results
Four studies involving 1642 participants made three eligible comparisons: (i) personal assistance versus usual care, (ii) personal assistance versus nursing homes, and (iii) personal assistance versus 'cluster care'. One was an RCT, three were non-randomised. Personal assistance was generally preferred over other services; however, some people prefer other models of care. This review indicates that personal assistance probably has some benefits for some recipients and caregivers. Paid assistance probably substitutes for informal care and may cost government more than alternatives; however, the total costs to recipients and society are currently unknown.Authors' conclusions
Research in this field is limited. Personal assistance is expensive and difficult to organise, especially in places that do not already have services in place. When implementing new programmes, recipients could be randomly assigned to different forms of assistance. While advocates may support personal assistance for myriad reasons, this review demonstrates that further studies are required to determine which models of personal assistance are most effective and efficient.
Montgomery Paul, Mayo-Wilson Evan, Dennis Jane A, Mayo-Wilson Evan
Personal assistance for older adults without dementia
Personal assistance is paid support of at least 20 hours per week for people with impairments. This review investigated the effectiveness of personal assistance versus any other form of care for older adults (65+). An exhaustive literature search identified 4 studies that met the inclusion criteria, which included 1642 participants. They suggested that personal assistance may be preferred over other services; however, some people prefer other models of care. This review indicates that personal assistance probably has some benefits for some recipients and their informal caregivers. Paid assistance might substitute for informal care and cost government more than alternative arrangements; however, the relative total costs to recipients and society are unknown.
Implications for practice
There have been relatively few controlled studies of personal assistance for older adults who require a great deal of assistance. Existing evidence suggests that personal assistance is generally preferred over other services by consumers and their representatives who agree to participate in research; however, some people prefer other models of care. This review indicates that personal assistance probably has some benefits for some recipients, their friends and families. Paid assistance probably substitutes for informal care and may cost government more than alternative arrangements; however, the relative total costs to recipients and society are unknown. Decisions to provide or not to provide and to take-up or not to take-up personal assistance will be informed by personal values and preferences in addition to evidence of its effectiveness.
This review indicates that personal assistance is safe for older adults, though it may be difficult to manage. People who choose to receive personal assistance may prefer it to other services, particularly services over which users have little control. However, this review does not indicate that personal assistance would be superior to other services for people who are already satisfied with the assistance they receive. Personal assistance appears to benefit informal caregivers as well. Individuals considering personal assistance may wish to discuss their options with family and friends.
Implications for research
In 1986, Ratzka noted that 'there has been surprisingly little in the way of policy evaluation. The work that has been done in this area is restricted to gathering descriptive statistics on number of hours provided by one type of service, number of consumers, staff, and expenditures'. While several studies have been conducted since the 1980s, few studies have compared directly personal assistance and other services and further evaluations are required to determine the relative merits of different ways of organising assistance.
Personal assistance is expensive and difficult to organise, especially in places that do not have such services in place already. In locations with personal assistance, recipients may resist being assigned to other services. Nonetheless, it would be possible to compare personal assistance to other services or to different forms of personal assistance in locations implementing new programmes. Similarly, new users might be assigned to new models of personal assistance in places with long-standing personal assistance services.
Services for older adults with impairments are organised differently around the world. While advocates may support personal assistance for myriad reasons, this review demonstrates that further studies are required to determine (i) what marginal benefits are gained from personal assistance (i.e. the added value compared to other services that exist today), (ii) at what total relative cost and (iii) which models of personal assistance are most effective and efficient.Get full text at The Cochrane Library
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