Skip to main content
SpringerLink
Log in

Community care in Europe. The Aged in HOme Care project (AdHOC)

  • Original Articles
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background and aims: Community care for older people is increasing dramatically in most European countries as the preferred option to hospital andlong-term care. While there has been a rapid expansion in Evidence-Based Medicine, apart from studies of specific interventions such as home visiting and hospital at home (specialist visits or hospital services provided to people in their own homes in the community), there is little evidence of characteristics of the recipients of community care services or the organisation of services that produce the best outcomes for them and their informal carers. The AdHOC Study was designed to compare outcomes of different models of community care using a structured comparison of services and a comprehensive standardised assessment instrument across 11 European countries. This paper describes the study and baseline data. Methods: 4,500 people 65 years and older already receiving home care services within the urban areas selected in each country were randomly sampled. They were assessed with the MDS-HC (Minimum Data Set-Home Care) instrument, containing over 300 items, including socio-demographic, physical and cognitive characteristics of patients as well as medical diagnoses and medications received. These data were linked to information on the setting, services structures and services utilization, including use of hospital and long-term care. After baseline assessment, patients were re-evaluated at 6 months with an abbreviated version of the instrument, and then at the end of one year. Data collection was performed by specially-trained personnel. In this paper, socio-demographics, physical and cognitive function and provision of hours of formal care are compared between countries at baseline. Results: The final study sample comprised 3,785 patients; mean age was 82±7.2 years, 74.2% were females. Marital and living status reflected close family relationships in southern Europe relative to Nordic countries, where 5 times as many patients live alone. Recipients of community care in France and Italy are characterised by very high physical and cognitive impairment compared with those in northern Europe, who have comparatively little impairment in Activities of Daily Living and cognitive function. The provision of formal care to people with similar dependency varies extremely widely with very little formal care in Italy and more than double the average across all levels of dependency in the UK. Conclusions: The AdHOC study, by virtue of the use of a common comprehensive standardised assessment instrument, is a unique tool in examining older recipients of community care services in European countries and their widely varied organisation. The extreme differences seen in dependency and hours of care illustrate the probable contribution the study will make to developing an evidence based on the structure, quantity and targeting of community care, which will have major policy implications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Carpenter I, Challis D, Hirdes J, Ljunggren G, Bernabei R. Care of older people: a comparison of systems in North America, Europe and Japan. London: Farrand Press, 1999.

    Google Scholar 

  2. Meerding W, Polder J, Bonneux L, Koopmanschap M, Van der Maas P. Health-care costs of ageing. Lancet 1998; 351: 140–1.

    Article  PubMed  CAS  Google Scholar 

  3. Levine SA, Boal J, Boling PA. Home care. JAMA 2003; 290: 1203–7.

    Article  PubMed  CAS  Google Scholar 

  4. Woolhandler S, Campbell T, Himmelstein DU. Costs of health care administration in the United States and Canada. N Engl J Med 2003; 349: 768–75.

    Article  PubMed  Google Scholar 

  5. Welch HG, Wennberg DE, Welch WP. The use of Medicare home health care services. N Engl J Med 1996; 335: 324–9.

    Article  PubMed  CAS  Google Scholar 

  6. Burge F, Lawson B, Johnston G. Trends in the place of death of cancer patients 1992–1997. CMAJ 2003; 168: 265–70.

    PubMed  Google Scholar 

  7. Steel K. Research on ageing: an agenda for all nations individually and collectively. JAMA 1997; 278: 1374–5.

    Article  PubMed  CAS  Google Scholar 

  8. Challis DJ. Care of the elderly in Europe. Eur J Gerontol 1992; 1: 334–47.

    Google Scholar 

  9. Saltman R, Figueras J. Analyzing the evidence of European health care reforms. Health Affairs 1998; 17: 85–106.

    Article  PubMed  CAS  Google Scholar 

  10. Ham C, Brommels M. Health care reforms in the Netherlands, Sweden and the United Kingdom. Health Affairs 1994; 13: 106–19.

    Article  PubMed  CAS  Google Scholar 

  11. CM5571. 2002 Spending Review: Public Service Agreements. London: HMSO, 2002.

    Google Scholar 

  12. Carpenter GI, Mor V, Phillips C. Continuing and rehabilitative care for the elderly: a comparison of countries and settings. Oxford: Age Ageing Suppl, 1997.

    Google Scholar 

  13. van Haastregt JCM, Diederiks JPM, van Rossum E, de Witte LP, Crebolder HFJM. Effects of preventive home visits to elderly people living in the community: systematic review. BMJ 2000; 320: 754–8.

    Article  PubMed  Google Scholar 

  14. Gentles H, Potter J. Alternatives to acute hospital care. Rev Clin Gerontol 2001; 11: 373–8.

    Article  Google Scholar 

  15. Vetter NJ, Lewis PA, Ford D. Can health visitors prevent fractures in elderly people? BMJ 1992; 304: 888–90.

    Article  PubMed  CAS  Google Scholar 

  16. van Haastregt JCM, Diederiks JPM, van Rossum E, de Witte LP, Voorhoeve PM, Crebolder HFJM. Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk. BMJ 2000; 321: 994–8.

    Article  PubMed  Google Scholar 

  17. Stuck AE, Aronow HU, Steiner A, et al. A trial of annual comprehensive geriatric assessments for elderly people living in the community. N Engl J Med 1995; 333: 1184–9.

    Article  PubMed  CAS  Google Scholar 

  18. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032–6.

    Article  PubMed  CAS  Google Scholar 

  19. Williams EI, Greenwell J, Groom LM. The care of people over 75 years of age after discharge from hospital: an evaluation of timetabled visiting by health visitor assistants. J Public Health Medicine 1992; 14: 138–44.

    CAS  Google Scholar 

  20. Dunn RB, Lewis PA, Vetter NJ, Guy PM, Hardman CS, Jones RW. Health visitor intervention to reduce days of unplanned hospital re-admission in patients recently discharged from geriatric wards: the results of a randomised controlled study. Arch Gerontol Geriatr 1994; 18: 15–23.

    Article  PubMed  CAS  Google Scholar 

  21. Elkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: systematic review and meta-analysis. BMJ 2001; 323: 1–9.

    Article  Google Scholar 

  22. Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 2002; 287: 1022–8.

    Article  PubMed  Google Scholar 

  23. Illsley R. In Jamieson A, ed. Home care for older people in Europe: a comparison of policies and practices. Oxford: Oxford University Press, 1991.

  24. Bernabei R, Landi F, Gambassi G, et al. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ 1998; 316: 1348–51.

    Article  PubMed  CAS  Google Scholar 

  25. Bula CJ, Berod AC, Stuck AE, et al. Effectiveness of preventive in-home geriatric assessment in well functioning, community-dwelling older people: secondary analysis of a randomized trial. J Am Geriatr Soc 1999; 47: 389–95.

    PubMed  CAS  Google Scholar 

  26. Reuben DB, Frank JC, Hirsch SH, McGuigan KA, Maly RC. A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations. J Am Geriatr Soc 1999; 47: 269–76.

    PubMed  CAS  Google Scholar 

  27. Rubenstein L, Wieland D, Bernabei R. Geriatric Assessment Technology: the state of the art. Milan: Editrice Kurtis, 1995.

    Google Scholar 

  28. HennekensCH, Buring JE, Mayrent SL. Epidemiology in Medicine, 1987.

  29. Morris JN, Fries BE, Steel K, et al. Comprehensive clinical assessment in community setting — applicability of the MDS-HC. J Am Geriatr Soc 1997; 45: 1017–24.

    PubMed  CAS  Google Scholar 

  30. Sgadari A, Morris J, Fries B, et al. Efforts to establish the reliability of the Resident Assessment Instrument. Age Ageing 1997; 26-S2: 27–30.

    Article  Google Scholar 

  31. Carpenter GI, Teare GF, Steel K, et al. A new assessment for elders admitted to acute care: reliability of the MDS-AC. Aging Clin Exp Res 2001; 13: 316–30.

    CAS  Google Scholar 

  32. Landi F, Onder G, Tua E, et al. Impact of a new assessment system, the MDS-HC, on function and hospitalization of home bound elderly: a controlled clinical trial. J Am Geriatr Soc 2001; 49: 1288–93.

    Article  PubMed  CAS  Google Scholar 

  33. Morris JN, Carpenter GI, Berg K, Jones RN. Outcome measures for use with home care clients. Can J Aging 2000; 19 S2: 87–105.

    Article  Google Scholar 

  34. Landi F, Lattanzio F, Gambassi G, Zuccalà G, Sgadari A, Panfilo M. A model for integrated home care of frail older patients: the Silver Network Project. Aging Clin Exp Res 1999; 12: 262–72.

    Google Scholar 

  35. Leung AC, Liu CP, Tsui LL, et al. The use of the Minimum Data Set: home care in a case management project in Hong Kong. Care Manag J 2001; 3: 8–13.

    PubMed  CAS  Google Scholar 

  36. Landi F, Tua E, Onder G, et al. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care 2000; 38: 1184–90.

    Article  PubMed  CAS  Google Scholar 

  37. Morris JN. Fries BE, Morris SA. Scaling ADL’s within the MDS. J Gerontol 1999; 4: M546-53.

    Google Scholar 

  38. Morris JN, Fries BE, Mehr DR, et al. The MDS Cognitive Performance Scale. J Gerontol 1994; 49: 174–82.

    Article  Google Scholar 

  39. Frederiksen K, Tariot P, De Jonghe E. Minimum Data Set Plus (MDS+) scores compared with scores from five rating scales. J Am Geriatr Soc 1996; 44: 305–9.

    PubMed  CAS  Google Scholar 

  40. Burrows A, Morris J, Simon S, Hirdes J, Phillips C. Development of an MDS-based Depression Rating Scale for use in nursing homes. Age Ageing 2000; 29: 165–72.

    Article  PubMed  CAS  Google Scholar 

  41. Bjorkgren MA, Fries BE, Shugarman LR. A RUG-III case-mix system for home care. Can J Aging 2000; 19 S2: 106–25.

    Article  Google Scholar 

  42. Kinnunen K. Postponing of institutional long-term care in the patients at high risk of institutionalization. Doctoral thesis. 2002.

  43. Andersson A, Levin LA, Oberg B, Mansson L. Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke. Scand J Caring Sci 2002; 16: 386–92.

    Article  PubMed  Google Scholar 

  44. Marchionni N, Fattirolli F, Fumagalli S, et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation 2003; 107: 2201–9.

    Article  PubMed  Google Scholar 

  45. Hermiz O, Comino E, Marks G, Daffurn K, Wilson S, Harris M. Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease. BMJ 2002; 325: 938–40.

    Article  PubMed  Google Scholar 

  46. McAlister FA, Lawson FME, Teo KK, Armstrong PW. Randomised trials of secondary prevention programmes in coronary heart disease: systematic review. Am J Med 2001; 110: 378–84.

    Article  PubMed  CAS  Google Scholar 

  47. Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med 2003; 347: 1068–74.

    Article  Google Scholar 

  48. Hannan EL, Magaziner JU, Wang JJ, et al. Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 2001; 285: 2736–42.

    Article  PubMed  CAS  Google Scholar 

  49. Coupland R. Effective health visiting for elderly people. Health Visitor 1986; 59: 299–300.

    PubMed  CAS  Google Scholar 

  50. Stoddart H, Whitley E, Harvey I, Sharp D. What determines the use of home care services by elderly people? Health Soc Care Community 2002; 10: 348–60.

    Article  PubMed  Google Scholar 

  51. Kunkel SR, Appelbaum RA. Estimating the prevalence of long-term disability for an aging society. J Gerontol 1992; 47: S253–5.

    Article  PubMed  CAS  Google Scholar 

  52. Carpenter G, Hirdes J, Ribbe M, et al. Targeting and quality of nursing home care. A five nation study. Aging Clin Exp Res 1999; 11: 83–9.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Health Services Studies, George Allen Wing, University of Kent, Canterbury, Kent, CT2 7NF, UK

    Iain Carpenter MD, FRCP

  2. Department Geriatrics, 1st Medical Faculty, Charles University and Institute of Postgraduate Medical Education, Prague, Czech Republic

    Giovanni Gambassi & Eva Topinkova

  3. Bispebjerg Hospital, Copenhagen, Denmark

    Marianne Schroll

  4. STAKES/CHESS, Helsinki, Finland

    Harriett Finne-Soveri

  5. Centre of Gerontology, Sainte Perine Hospital, Paris

    Jean-Claude Henrard

  6. Institut für Gesundheitsanalysen und soziale Konzepte e.V., Berlin, Germany

    Vjenka Garms-Homolova

  7. Department of Geriatrics, Landspitali — University Hospital, University of Iceland, Reykjavik, Iceland

    Palmi Jonsson

  8. PRISMANT, Utrecht, The Netherlands

    Dinnus Frijters

  9. Karolinska Institute, Stockholm, Sweden

    Gunnar Ljunggren

  10. The Decon College, Oslo, Norway

    Liv W. Sørbye

  11. NIVEL, Utrecht, The Netherlands

    Cordula Wagner

  12. Dipartimento di Scienze Gerontologiche, Università Cattolica Sacro Cuore, Roma, Italy

    Graziano Onder, Claudio Pedone & Roberto Bernabei

  13. Versailles-Saint-Quentin-en-Yvelines University, France

    Jean-Claude Henrard

Authors
  1. Iain Carpenter MD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Gambassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva Topinkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marianne Schroll
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harriett Finne-Soveri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean-Claude Henrard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vjenka Garms-Homolova
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Palmi Jonsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Dinnus Frijters
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gunnar Ljunggren
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Liv W. Sørbye
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Cordula Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Graziano Onder
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Claudio Pedone
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Roberto Bernabei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Iain Carpenter MD, FRCP.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carpenter, I., Gambassi, G., Topinkova, E. et al. Community care in Europe. The Aged in HOme Care project (AdHOC). Aging Clin Exp Res 16, 259–269 (2004). https://doi.org/10.1007/BF03324550

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324550

Keywords

Search

Navigation