Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The Cochrane Library contains several reviews on the effects of different ways of organising and delivering medical care. One of these reviews, published in March 2024, summarises the evidence on models for delivering medical care to older adults living in residential aged care facilities. In this podcast, Liesl Grobler talks with lead author, Polina Putrik, both from Monash University in Melbourne, Australia, about the review.

Liesl: Hello Polina, first of all, please tell us in one or two sentences why aged care is important?

Polina: Hello Liesl. Aged care facilities play a crucial role in supporting older individuals who can no longer live independently. With nearly one in three Europeans projected to be over 65 by 2060, the number of people residing in residential aged care facilities will continue to grow.

Liesl: So, why is it important to study the effects of different models of medical care in residential care?

Polina: Aged care residents are often frail, elderly individuals with multiple chronic health conditions. When care facilities can’t meet their medical needs, they’re often transferred to hospitals, which poses a burden to residents and families. For example, up to 40% - so more than one third - of emergency visits and subsequent hospital admissions for aged care residents could be avoided. Care models differ in terms of coordination, the mix of healthcare professionals, and use of technology, such as telemedicine consultations. The effects of these differences have been evaluated and summarizing this research in a Cochrane review helps us identify the models that provide better value for money.

Liesl: How much research did you find?

Polina: We examined 40 trials involving over 21,000 people from 16 countries. Most of these trials were conducted in the last decade, indicating a growing interest in this field. We categorized different care models based on their focus. For example, some models emphasize care coordination, while others compare the outcomes of treating residents within nursing homes versus transferring them to hospitals.
We carefully examined several key outcomes, such as emergency care utilization, hospital admissions, resident safety, well-being, and adherence to clinical guidelines. However, none of the studies measured all of these outcomes. As a result, the available evidence was limited, even though there were so many trials. The trials also varied significantly in terms of intervention features and the usual care practices in different countries. This diversity made it challenging to combine results and obtain a comprehensive overview.

Liesl: With that in mind, what do these trials tell us? Do we know which model is best to use?

Polina: Our analysis revealed that when it comes to organizing and delivering medical care for aged care residents, changing the approach may make little or no difference to the number of emergency department visits and alternative care models may have little or no effect on residents’ health-related quality of life and probably make little to no difference to mortality. However, it may reduce unplanned hospital admissions We’re uncertain about the effects on adverse events and adherence to clinical guidelines. The economic evaluations provided by five trials which were focused on care coordination also leave us uncertain about whether alternative models are more cost-effective than usual care.

Liesl: To conclude, to whom are these findings particularly important and what’s your take-home message?

Polina: These findings hold significant relevance for policy-makers and care managers responsible for planning and organising care for aged care residents. Although most of the evidence has low certainty, we can tentatively conclude that models focusing on improving care coordination may reduce hospital admissions compared to usual care. A key takeaway is that despite the growing number of trials, we still lack high-quality evidence on effective care models for older adults in residential settings. Existing evidence has methodological limitations and new care models should not be implemented or scaled up without thorough evaluation.

Liesl: Thanks Polina. If people would like to read the review, how can they get hold of it?

Polina: Thanks Liesl. The review’s available online and if listeners go to www Cochrane Library dot com and type “alternative care models in aged care facilities” in the search box they will see our review near the top of the list.