We reported “NA” if the item was not applicable. In two studies, we found no significant differences. A quasi-experimental, controlled, multi-centre study, Promotion of health in older people: a randomised controlled trial of health risk appraisal in British general practice, A collaborative care model of health risk assessment and counselling in older persons: a pragmatic randomised clinical trial, The clinical effectiveness and cost-effectiveness of home-based, nurse-led health promotion for older people: a systematic review, Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis, Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis, Effectiveness of an interdisciplinary primary care approach to reduce disability in community dwelling frail older people, © The Author 2016. We would expect that an improvement in behaviour through CHW counselling and education could also have improved knowledge. There are approximately 100 NORCs, half in New York and the rest scattered throughout the USA [30]. The following section summarizes information about four commonly used community-based agencies that provide these services. Socialization occurs in the setting of congregate meals that are served in the community through senior centers, day health programs, and other venues. Public Health Nurs. The preoccupation of doctors with disease to the detriment of its social consequences, the failure to take into account the adaptive powers of older people and the tendency to underestimate the burden borne by carers were all identified as major obstacles to progress in developing more effective primary care for older people. Researchers can target the frail and pre-frail, those older people who are ‘hard to reach’ or the middle aged who are ready to change their behaviour and, for example, increase their physical activity. Local programs generally welcome the opportunity to have clinicians come in to do presentations on specific topics related to health; both the clinician and the CBSS can establish a mutually beneficial collaborative relationship. No statistically significant differences were found for smoking. The ER for this study was 0.43. Verhagen, I., Steunenberg, B., de Wit, N.J. et al. The development of geriatric medicine services in some countries may have reduced the capacity of new interventions to alter outcomes. Steve Iliffe, Community-based interventions for older people with complex needs: time to think again?, Age and Ageing, Volume 45, Issue 1, January 2016, Pages 2–3, https://doi.org/10.1093/ageing/afv185. Assessing a patient’s faith community may also help the clinician when thinking about options for community support. . ADS use is growing. national websites that list links (these may not be up to date, if a site has moved): National Association of Area Agencies on Aging: search at the state level: office or department of aging (which will usually list the AAAs by county). Over the past decade participation in senior centers has declined, especially for the younger, healthier segments of the older population [19], giving rise to a movement to create more flexible and responsive models that will attract a broader range of individuals and be able to meet a diversity of needs. PubMed  Negative experiences still accumulate, however. Article  A newer alternative, known as Villages, is membership-driven and privately funded, originating most often in areas of greater wealth [30]. Accessing Community-Based Services (1) National Eldercare Locator: http://www.eldercare.gov/: (a) by zip code, (b) by service, (c) toll-free number: 1-800-677-1116. The first NORC was created in 1986 at a housing development (Penn South Houses) in New York City to support a group of the elderly who had aged in place but required a support system to enable them to continue to live independently in the community [28]. As a result of our selection process, 729 studies were identified in PubMed. The mean ER for the outcome category ‘access to care’ was 0.58. We searched the PubMed database (2002-Present) for RCTs published on the use of CHWs in Western countries. The outcomes of the studies were reported in three different categories: access to care, health behaviour, and health status (Additional file 1: Table S1). We exclude certified home health services (such as visiting nurse or home physical therapy) and state Medicaid waiver programs to focus the discussion on individual organizations less familiar to clinicians. In practice, CHWs are employed in various programmes to reduce disparities in health, most frequently related to specific health conditions such as cancer, diabetes, hypertension, asthma, nutrition, and tobacco control [12]. The total score for the methodological quality was calculated by summing the subscores. Dr. Eugenia L. Siegler receives royalties from Springer Publishing Company. Improving later life. The number of older adults from ethnic minorities is increasing rapidly in Western countries, and their utilisation of health facilities has been reported to lag behind [5]. Gagnon AJ, Schein C, McVey L, Bergman H. Marshall BS, Long MJ, Voss J, Demma K, Skerl KP. Two reviewers (IV and BS) independently performed the methodological quality assessment of the included studies. The settings in which interventions are launched may determine outcomes; countries with less developed primary care and less extensive geriatric medicine may benefit most from community-based interventions. Health promotion for older adults living in the community is directed at interventions and services to prolong … In the UK, the Medical Research Council trial [7] compared universal versus targeted assessments of the 75 and over population, and management by primary care teams versus multidisciplinary geriatric teams. Love MB, Gardner K, Legion V: Community health workers: who they are and what they do. The effectiveness of nutrition support programs has been studied; data suggest that home delivered meals can reduce nursing home admissions [15, 16]. (4) Web search for the individual service: (a) example  1: nutrition: (i) search globally (rather than just “meals on wheels”) for home delivered or congregate meals or nutrition assistance, (ii) counseling and other forms of nutrition support may be available, (b) example  2: senior centers: (i) these will usually be called senior center but they may be listed as a subcategory under community resources or congregate meals, (c) example  3: adult day services centers: http://nadsa.org/consumers/choosing-a-center/, (d) example  4: naturally occurring retirement communities: https://www.norcs.org/. IV extracted the data and drafted the manuscript. PubMed  1997, Churchill Livingstone, New York. Many studies examining the effectiveness of senior centers have been cross-sectional or had methodological weaknesses [18]; a few controlled trials have examined specific interventions (e.g., exercise, education) delivered at senior centers and suggested improved outcomes [18, 19]. In a study on reducing diabetes risk factors among African Americans, none of the behaviours (dietary risk score, leisure-time physical activity, or BMI) showed significant differences [24]. Many of these older adults will continue to live and enjoy life in their communities. Three-fourths of these programs offer medication management for mental health disorders [23]. No statistically significant differences in the completion of endoscopy at three months were found. PubMed  Article  The national aging services network through which the AoA promotes home and community-based services consists of 56 state (and territorial) units on aging, 629 area agencies on aging (AAA), 256 Native American and Native Hawaiian organizations, together with the tens of thousands of direct service providers and volunteers [3]. The minimum age was set to 50 because adults belonging to ethnic minority groups often experience health problems at a younger age than the majority population [15]. 10.1111/j.1547-5069.2004.04064.x. Target population: ethnic minority older adults (50 years and over). This study included an integrated model of care between primary and secondary care providers, with weekly multidisciplinary reviews of each patient's case. Six studies reported the comparability of treatment (except the introduction of CHWs). Jandorf L, Gutierrez Y, Lopez J, Christie J, Itzkowitz SH: Use of a patient navigator to increase colorectal cancer screening in an urban neighborhood health clinic. Swider SM: Outcome effectiveness of community health workers: an integrative literature review. Community health worker interventions to improve access to health care services for older adults from ethnic minorities: a systematic review. Significant positive changes in the readiness to engage in vigorous physical activity and take up new physical activity were reported in the CHW arm compared to the usual care arm. Interventions can be built around different options for physical activity, dietary change or increasing self-efficacy. café programs for adults 50 years and over that mix age groups and provide a community space for meals, education, and entertainment. We did not find negative effects in any of the studies. Cookies policy. The first senior center (William Hodson) opened in 1943 in New York City. Navigating CBSS can be challenging. Nutritional service programs are directed toward those with significant impairments. 10.1093/jurban/jti046. For better interpretation of the results, effect ratios (ERs) were calculated as the number of positive findings divided by the total number of measured findings. NORCs are public-private partnerships and receive support both from local agencies and the federal government, via Title IV of the OAA [29].

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