Substudy 13 Executive Summary
Substudy 13: The Victoria Geriatric Outcome and Evaluation Study
by Holly Tuokko
To address the issue of substitutability of services within an existing structured geriatric services program, data were obtained for all persons admitted to each of the 5 service components (i.e., outpatient - Geriatric Outpatient Clinic and Geriatric Day Hospital; inpatient - inpatient - Postacute geriatric rehabilitation [7C], Geriatric rehabilitation for persons admitted directly from the community [7D], and Psychogeriatric Rehabilitation [Homer 2] ). Measures of mental health, physical health, daily functioning and bodily pain were administered to persons attending all of the services within the Geriatric Services Program at admission, discharge and 4 months post-discharge. Measures of health status, depression and reactions to caregiving were administered to family members involved in providing care to these persons at admission, discharge and 4 months post-discharge. Data on health care utilization and costs of care were obtained through existing data bases, manual record review and report of caregivers and addressed issues related to costs of self-care, informal care, and formal care.
The central finding of this study was that persons admitted to each of the service components of the geriatric services program differed with respect to their profile of mental health, physical health, daily functioning and bodily pain. This supports the notion that these services represent a spectrum of care and that one service is not substitutable for another. That is, each service is addressing the needs of a specific subpopulation. Within each service, health status appeared to improve when receiving care, and examination of the sustainability of improved health status over time supported the present model of care in that little change in functioning was seen from discharge until 4 months post-discharge. Unfortunately, we were unable to assess the cost-effectiveness of the various services and so it was not possible to determine if there could be a cost-effective substitution of services.
These findings support the notion that a spectrum of care services are required for geriatric care and that health benefits are realized and sustained across a broad spectrum of services. Included in this report are some of the many valuable lessons learned during the implementation phase of the study. This report addresses only the findings relevant to the specific objectives of the project. The rich data available will be further examined with respect to a variety of specific topics in the future.