A report published in the Journal of the American Geriatrics Society reviews the conditions and quality of care available for elderly people living in assisted living facilities (ALF) versus those receiving care at home. According to the authors, the number of older adults in the United States is constantly increasing and is expected to grow over the next 35 years (Ortman, Velkoff, & Hogan, 2014). Thus, the research is aimed at assessing the current quality of conditions and the resulting health outcomes for the residents of assisted living facilities to determine the current state of affairs and to locate the issues that hamper the quality of their life to be able to address them timely.
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The study was conducted by obtaining the information from several electronic databases and applying the quantitative analysis aimed primarily at certain health issues characteristic for the elderly population and comparing the results to the people who were receiving care at home. The report has found noticeable differences in several areas of health as well as care approaches and behavior characteristics of both groups. While no definitive conclusion was reached, the report has outlined the generalized picture of the quality of life and health of the older people, as well as shown the promising directions for further research.
The aim of this paper is a critical review of the report aimed at determining the health and quality of life outcomes for Mary and her husband in case they move to an assisted living center compared to the possibility of staying at home and receiving care there. In this regard, the statistical analysis performed in the 2015 study offers a valuable comparison relevant for the research and consistent with the PICO(T) question.
The research is a quantitative retrospective cohort study of the data obtained from the electronic health record (EHR) of 12 hospices. Several elements were compared, such as the severity of illness, the complexity of care and the equipment required for performing it, the health conditions and medications that address them, the length of stay, and the health trends.
The sample included all of the patients from the twelve hospices that were admitted between January 2008 and May 2012. The total number of participants was thus 163,914 individuals, of which 8.7 percent were residents of the assisted living facilities while 91.3 percent were receiving care at home. The number of the participants is small relative to the 1.6 million hospice patients admitted to ALF every year.
However, the percentage aligns well with the share of residents of ALF, being 7% overall and 8.7% in the study (Dougherty, Harris, Teno, Corcoran, Douglas, Nelson, Way, Harrold, & Casarett, 2015). Finally, the basic demographic variables, like race, sex, and age, as well as basic diagnostic information was taken into account to further improve the results. Thus, the number is sufficient for a preliminary study.
Data Collection Methods
The data was extracted from the single electronic health record (EHR) database used by the Coalition of Hospices Organized to Investigate Comparative Effectiveness (CHOICE) after the agreement have been obtained from the steering committee comprising the leaders of all twelve establishments (Casarett, Harrold, Oldanie, Prince-Paul, & Teno, 2012). The data was stripped of all personal information to comply with the Health Insurance Portability and Accountability Act and was encrypted before the transportation to ensure the privacy and security of data.
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Each participant has ascribed a Palliative Performance Scale (PPS) score, which assesses functional status by focusing on the ambulation, activity, self-care, intake, and level of consciousness. The results were grouped into three categories, ranging from 0 to 30, 30 to 50, and 50 to 100, accordingly. Additionally, the length of stay in ALF and the site of death were taken into account. The resulting data was analyzed using the univariate logistic regression models, with the inclusion of the potential predictors and inclusion of variables based on their importance in the final model. The Stata statistical software (MP2 version 11.0, StataCorp., College Station, TX) was used for the analysis.
Three main limitations of this study must be recognized. First, twelve assisted living facilities is rather a small number and does not allow for the definitive conclusion. Additionally, it should be noted that the study was aimed at the state health program, and thus only reviewed non-profit establishments, which also limits the scope. Second, the study has utilized the most generalized information without the inclusion of personalized data, which does not allow the complete understanding and thus restricts the determination of causes to speculation. Third, the data was processed in a single bulk, so no differences between individual ALFs could be accounted for.
Depending on the aim of the subsequent studies, the limitations can be overcome by covering the larger number of databases and including a more diverse range of facilities for the more accurate statistical results, or the inclusion of the individual factor, ranging from the isolation of data from separate facilities to the interviews with personnel and patients for a more in-depth study of the reasons behind the obtained results.
The results have shown several tendencies after contrasting two groups. The residents of assisted living facilities enroll in hospices earlier than the population that receives care at home. The reasons for this are unclear but are most likely connected to the higher predictability and monitoring capacity of the ALFs. Second, the ALF the majority of residents are staying there until death, which may be due to the preference of available treatment and professional nursing level over complexities of home care.
However, the data is insufficient for confirming this. Third, the ALF residents are less likely to receive opioids in the case of pain, despite the comparable prevalence of pain in two groups. Finally, the ALF residents are less likely to die in the hospital or the inpatient hospice unit. While the consistency of care is a tempting conclusion to draw from this result, there is no data to support the assumption, so additional research is required to determine the reasons behind the results.
The same can be said regarding the research question. All the findings are consistent with the assumption that assisted living center is superior in terms of care, medical aid, and quality of life over the care given at home. Nevertheless, the results can not be conclusively ascribed to these reasons based solely on the report in question. Nevertheless, while the additional research is needed to improve the understanding of the results, the preferred intervention for Mary and her husband based on the available information is still moving to the assisted living center.
The results of the report are consistent with the initial hypothesis that the care provided by the ALF is superior to home-based care. Thus, no radical change in practice is needed, as no issues were found by the research. However, the research has limitations which may prove crucial in the later stages, when some unaccounted issues may become visible. The suggested strategy is thus the in-depth review of the reasons behind the obtained results that will confirm the speculations made by the research team.
Casarett, D. J., Harrold, J., Oldanie, B., Prince-Paul, M., & Teno, J. (2012). Advancing the science of hospice care: coalition of hospices organized to investigate comparative effectiveness. Current Opinion in Supportive and Palliative Care, 6(4), 459-464.
Dougherty, M., Harris, P. S., Teno, J., Corcoran, A. M., Douglas, C., Nelson, J., Way, D., Harrold, J., & Casarett, D. J. (2015). Hospice care in assisted living facilities versus at home: results of a multisite cohort study. Journal of the American Geriatrics Society, 63(6), 1153-1157. Web.
Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014). An aging nation: the older population in the United States. Washington, DC: US Census Bureau, 25-1140.