A Home-Care Service for Frail Older Adults: Findings from a Quasi-Experiment in Milan

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Abstract

Population aging is particularly pronounced in Italy. Recently, home-care services emerged as one of the desirable strategy when dealing with such situations of fragility. In this framework, we present the evaluation of a home-care service which was experimentally implemented by Fondazione Sacra Famiglia and Casa di Cura Ambrosiana in the 2017–2018 biennium. The service consisted of a twice-weekly nursing visit intended to monitor patient health conditions and to gather data constantly supervised by a geriatrician. The eligible population consisted of the users of San Carlo Hospital Emergency Department (91 individuals). Twenty of these individuals had access to the experimental home-care service. The results show the smaller probability of mortality for the treatment group compared to the control group, but similar probabilities in admissions to ER and in hospitalizations. These findings suggest that health home-care policies could reduce mortality by lessening the negative effects of relational isolation.

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Most cited references 16

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Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

Julianne Holt-Lunstad, Timothy B Smith, Mark Baker … (2015)

Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.

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A Test of Missing Completely at Random for Multivariate Data with Missing Values

Roderick J A Little (1988)

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COVID-19 and the consequences of isolating the elderly

Richard A. Armitage, Laura Nellums (2020)

As countries are affected by coronavirus disease 2019 (COVID-19), the elderly population will soon be told to self-isolate for “a very long time” in the UK, and elsewhere. 1 This attempt to shield the over-70s, and thereby protect over-burdened health systems, comes as worldwide countries enforce lockdowns, curfews, and social isolation to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, it is well known that social isolation among older adults is a “serious public health concern” because of their heightened risk of cardiovascular, autoimmune, neurocognitive, and mental health problems. 2 Santini and colleagues 3 recently demonstrated that social disconnection puts older adults at greater risk of depression and anxiety. If health ministers instruct elderly people to remain home, have groceries and vital medications delivered, and avoid social contact with family and friends, urgent action is needed to mitigate the mental and physical health consequences. Self-isolation will disproportionately affect elderly individuals whose only social contact is out of the home, such as at daycare venues, community centres, and places of worship. Those who do not have close family or friends, and rely on the support of voluntary services or social care, could be placed at additional risk, along with those who are already lonely, isolated, or secluded. Online technologies could be harnessed to provide social support networks and a sense of belonging, 4 although there might be disparities in access to or literacy in digital resources. Interventions could simply involve more frequent telephone contact with significant others, close family and friends, voluntary organisations, or health-care professionals, or community outreach projects providing peer support throughout the enforced isolation. Beyond this, cognitive behavioural therapies could be delivered online to decrease loneliness and improve mental wellbeing. 5 Isolating the elderly might reduce transmission, which is most important to delay the peak in cases, and minimise the spread to high-risk groups. However, adherence to isolation strategies is likely to decrease over time. Such mitigation measures must be effectively timed to prevent transmission, but avoid increasing the morbidity of COVID-19 associated with affective disorders. This effect will be felt greatest in more disadvantaged and marginalised populations, which should be urgently targeted for the implementation of preventive strategies.

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Author and article information

Contributors

Simone Sarti:

ORCID: http://orcid.org/0000-0001-5791-8793

simone.sarti@unimi.it

Bio :

Simone Sarti

is Professor at the University of Milan.

Francesco Molteni:

ORCID: http://orcid.org/0000-0002-5738-6464

francesco.molteni@unimi.it

Bio :

Francesco Molteni

is Postdoc researcher at the University of Milan.

Federica Cretazzo:

ORCID: http://orcid.org/0000-0001-5146-5535

federica.cretazzo@unito.it

Bio :

Federica Cretazzo

is PhD student at the University of Turin.

Gianluca Giardini: ggiardini@sacrafamiglia.org

Bio :

Gianluca Giardini

is Geriatrician at the Foundation Sacra Famiglia.

Stefania Pozzati: spozzati@sacrafamiglia.org

Bio :

Stefania Pozzati

is Social Director at the Foundation Sacra Famiglia. Stefania Pozzati is Social Director at the Foundation Sacra Famiglia.

Oriana Bruno: obruno@sacrafamiglia.org

Bio :

Oriana Bruno

is PhD in sociology at the Strategic Innovation Unit of the Foundation Sacra Famiglia.

Journal

Journal ID (nlm-ta): Ageing Int

Journal ID (iso-abbrev): Ageing Int

Title: Ageing International

Publisher: Springer US (New York )

ISSN (Print): 0163-5158

ISSN (Electronic): 1936-606X

Publication date (Electronic): 22 September 2021

Publication date PMC-release: 22 September 2021

Pages: 1-12

Affiliations

[1 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Social and Political Sciences, , University of Milan, ; Via Conservatorio, Milan, Italy

[2 ]GRID grid.7605.4, ISNI 0000 0001 2336 6580, SOMET Ph.D. Programme – NASP, , University of Turin, ; Turin, Italy

[3 ]Fondazione Sacra Famiglia, Milan, Italy

Author information

Simone Sarti http://orcid.org/0000-0001-5791-8793

Francesco Molteni http://orcid.org/0000-0002-5738-6464

Federica Cretazzo http://orcid.org/0000-0001-5146-5535

Article

Publisher ID: 9462

DOI: 10.1007/s12126-021-09462-6

PMC ID: 8456187

SO-VID: 6e7fb4eb-8caa-4f30-aebc-28099407c683

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date accepted : 4 August 2021

Funding

Funded by: Università degli Studi di Milano

Open Access :

Open access funding provided by Università degli Studi di Milano within the CRUI-CARE Agreement.

A Home-Care Service for Frail Older Adults: Findings from a Quasi-Experiment in Milan

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Most cited references 16

Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

A Test of Missing Completely at Random for Multivariate Data with Missing Values

COVID-19 and the consequences of isolating the elderly

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