Utilization and Cost Effects of the VHA Caring for Older Adults and Caregivers at Home (COACH) Program

2020 ◽  
pp. 107755872092959
Author(s):  
Wei Song ◽  
Orna Intrator ◽  
Jack Twersky ◽  
Judith Davagnino ◽  
Bruce Kinosian ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Emergency Services ◽  
Average Treatment Effect ◽  
Community Dwelling ◽  
Care Utilization ◽  
Veterans Health ◽  
Health Administration ◽  
Coach Program ◽  
At Home

Since 2010, the Veterans Health Administration has initiated a home-based Caring for Older Adults and Caregivers at Home (COACH) program to provide clinical support to dementia patients and family caregivers. But its impact on health care utilization and costs is unknown. We compared 354 COACH care recipients with a propensity score weighted comparison group of 9,857 community-dwelling Veterans during fiscal years 2010-2015. In 1-year follow-up, COACH program was associated with a lower rate of long-term nursing home placement (average treatment effect on the treated [ATT] –3%; p = .01). The program increased utilization of emergency services (ATT 6%; p = .01), hospitals (ATT 10%; p < .001), and personal care services (ATT 31%; p < .001). Health care costs were also significantly increased. Improved access to services may have enabled COACH Veterans to stay at home longer. As one of Veterans Health Administration’s top priorities to expand caregiver assistance programs, COACH seems to be a promising model for a nationwide implementation.

scholarly journals Health Care Utilization Among Texas Veterans Health Administration Enrollees Before and After Hurricane Harvey, 2016-2018

2021 ◽  
Vol 4 (12) ◽  
pp. e2138535
Author(s):  
Margaret Carrel ◽  
Gosia S. Clore ◽  
Seungwon Kim ◽  
Mary Vaughan Sarrazin ◽  
Eric Tate ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Veterans Health Administration ◽  
Care Utilization ◽  
Veterans Health ◽  
Health Administration ◽  
Before And After

Leisure-Time Physical Activity and Health-Care Utilization in Older Adults

2006 ◽  
Vol 14 (4) ◽  
pp. 392-410 ◽  
Author(s):  
Michelle Y. Martin ◽  
M. Paige Powell ◽  
Claire Peel ◽  
Sha Zhu ◽  
Richard Allman
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Leisure Time ◽  
Leisure Time Physical Activity ◽  
Community Dwelling ◽  
Care Utilization ◽  
Physically Active ◽  
Physician Visits

This study examined whether leisure-time physical activity (LTPA) was associated with health-care utilization in a racially diverse sample of rural and urban older adults. Community-dwelling adults (N= 1,000, 75.32 ± 6.72 years old) self-reported participating in LTPA and their use of the health-care system (physician visits, number and length of hospitalizations, and emergency-room visits). After controlling for variables associated with health and health-care utilization, older adults who reported lower levels of LTPA also reported a greater number of nights in the hospital in the preceding year. There was no support, however, for a relationship between LTPA and the other indicators of health-care utilization. Our findings suggest that being physically active might translate to a quicker recovery for older adults who are hospitalized. Being physically active might not only have health benefits for older persons but also lead to lower health-care costs.

Multidimensional Social Support and Health Services Utilization Among Noninstitutionalized Older Persons in Ghana

2018 ◽  
Vol 32 (3-4) ◽  
pp. 227-239 ◽  
Author(s):  
Razak M. Gyasi ◽  
David R. Phillips ◽  
Padmore Adusei Amoah
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Health Care ◽  
Health Services ◽  
Health Services Utilization ◽  
Community Dwelling ◽  
Health Care Use ◽  
Care Utilization ◽  
Health Seeking ◽  
Services Utilization

Objectives: This study examines multidimensional social supports as predictors of health services utilization among community-dwelling older Ghanaians. Method: Using data from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-Seeking Behavior Study ( N = 1,200), Poisson regression models estimated the associations of aspects of informal social support and health facility utilization among older people. Results: Findings suggest that regular contacts with family/close friends (odds ratio [OR] = 1.299; 95% confidence interval [CI] = [1.111, 1.519]), social participation (OR = 1.021; 95% CI = [1.140, 1.910]), and remittances from adult children (OR = 1.091; 95%CI = [1.086, 1.207]) were associated with increased health services utilization with some gender variations. Having caregivers increased health care use generally (OR = 1.108; 95% CI = [1.016, 1.209]) and among men (OR = 1.181; 95% CI = [1.015, 1.373]). However, we found decrease in health care use among those who received pecuniary assistance (OR = 0.893; 95% CI = [0.805, 0.990]). Discussion: Perceived structural and functional social support domains appear influential in health care utilization among older adults in Ghana. The findings underscore the need for intervention programs and social policies targeted at both micro-factors and wider social factors, including the novel area of remittances to older adults.

scholarly journals Evaluation of Peer-to-Peer Support and Health Care Utilization Among Community-Dwelling Older Adults

2020 ◽  
Vol 3 (12) ◽  
pp. e2030090 ◽  
Author(s):  
Elizabeth A. Jacobs ◽  
Rebecca Schwei ◽  
Scott Hetzel ◽  
Jane Mahoney ◽  
Katherine Sebastian ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Peer Support ◽  
Peer To Peer ◽  
Community Dwelling ◽  
Care Utilization ◽  
Community Dwelling Older Adults

scholarly journals The Five W’s of Falls: Weekly Online Health Survey of Community-Dwelling Older Adults: Analysis of 4 Years Prospective Follow-up

2019 ◽  
Vol 75 (5) ◽  
pp. 946-951 ◽  
Author(s):  
Antoine Piau ◽  
Nora Mattek ◽  
Colette Duncan ◽  
Nicole Sharma ◽  
Thomas Riley ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Community Dwelling ◽  
Falls Prevention ◽  
High Rate ◽  
Care Utilization ◽  
Walking Ability ◽  
Health Care Intervention ◽  
Time Period ◽  
Capture Method

Abstract Background An in-depth examination of prospectively collected falls details may facilitate more effective falls prevention. Who was involved? What happened? Where did the fall take place? When did it happen? Why did it occur? This study aimed to provide previously unavailable details about the circumstances surrounding fall events and their consequences. Method A retrospective analysis of falls prospectively self-reported by older adults via an online weekly health form over 4 years. Results We collected 371 falls during the 4 year time period from 120 clinically characterized fallers (74% women, mean age 83.3 years). Most of the 371 falls occurred indoors (62%) and in well-lit areas (81%). Bedrooms were the most common places for in-home falls. Commonly observed precipitating factors included loss of balance, slipping or tripping. Almost one-third (31%) of falls were defined as injurious whereas 22% resulted in a change in the walking ability of which 26% led to the use of a cane or walker. Among falls that did not give rise to any formal health care intervention, 8% resulted in a modification of walking ability. Conclusions A relatively high rate of fall-related injuries compared to the existing literature was observed. Online weekly surveys and the richness of details provided through these data capture method allowed us to identify falls that did not result in health care utilization but did result in decreased mobility. This finding suggests why some falls classified in the literature as noninjurious may nevertheless increase the risk of loss of autonomy and undesired outcomes.

scholarly journals Life-Space Predicts Health Care Utilization in Community-Dwelling Older Adults

2017 ◽  
Vol 31 (2) ◽  
pp. 280-292 ◽  
Author(s):  
Richard E. Kennedy ◽  
Courtney P. Williams ◽  
Patricia Sawyer ◽  
Alexander X. Lo ◽  
Kay Connelly ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Public Health Practice ◽  
Community Dwelling ◽  
Care Utilization ◽  
Life Space ◽  
Future Health ◽  
Future Health Care ◽  
Community Dwelling Older Adults

Objective: To determine whether decline in life-space mobility predicts increased health care utilization among community-dwelling older adults. Method: Health care utilization (number of emergency department [ED] visits and hospitalizations) was self-reported during monthly interviews among 419 community-dwelling African American and non-Hispanic White adults aged 75 years and older in The University of Alabama at Birmingham (UAB) Study of Aging II. Life-space was measured using the UAB Life-Space Assessment. Generalized estimating equations were used to examine associations of life-space at the beginning of each interval with health care utilization over the 1-month interval. Results: Overall, 400 participants were followed for 36 months. A 10-point decrease in life-space was associated with 14% increased odds of an ED visit and/or hospitalization over the next month, adjusting for demographics, transportation difficulty, comorbidity, and having a doctor visit in the last month. Discussion: Life-space is a practical alternative in predicting future health care utilization to performance-based measures, which can be difficult to incorporate into clinical or public health practice.

scholarly journals A Community Choir Intervention to Promote Well-Being Among Diverse Older Adults: Results From the Community of Voices Trial

2018 ◽  
Vol 75 (3) ◽  
pp. 549-559 ◽  
Author(s):  
Julene K Johnson ◽  
Anita L Stewart ◽  
Michael Acree ◽  
Anna M Nápoles ◽  
Jason D Flatt ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Costs ◽  
Intervention Group ◽  
Well Being ◽  
Community Dwelling ◽  
Care Utilization ◽  
Control Group ◽  
Significant Group ◽  
Care Costs

Abstract Objectives To test effects of the Community of Voices choir intervention on the health, well-being, and health care costs of racial/ethnically diverse older adults. Method Twelve Administration-on-Aging-supported senior centers were cluster randomized into two groups: the intervention group started the choir immediately and a wait-list control group began the choir 6 months later. The choir program was designed for community-dwelling adults aged 60 years and older. The multimodal intervention comprises activities that engage participants cognitively, physically, and socially. Outcome measures assessed these three domains as well as health care utilization and costs. The intention-to-treat comparison was at 6 months. Results The sample (N = 390) had a mean age of 71.3 years (SD = 7.2); 65% were nonwhite. Six-month retention was 92%. Compared to controls, intervention group members experienced significantly greater improvements in loneliness (p = .02; standardized effect size [ES = 0.34] and interest in life (p = .008, ES = 0.39). No significant group differences were observed for cognitive or physical outcomes or for health care costs. Discussion Findings support adoption of community choirs for reducing loneliness and increasing interest in life among diverse older adults. Further efforts need to examine the mechanisms by which engagement in choirs improves aspects of well-being and reduces health disparities among older adults, including potential longer-term effects. ClinicalTrials.gov Registration NCT01869179 registered January 9, 2013.

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