Assessing the impact of community-based services for older people

Background Ireland's population aged 65 and older increased by 40% in the last decade. To support older adults in ageing at home in Ireland, a national organisation delivers services through the Enhanced Community Care (ECC) programme. This programme promotes integrated health service delivery to better meet population needs. This presentation, structured around the RE-AIM Framework, shares findings on the effectiveness of community-based care coordination. Methods Phone-based surveys comprising demographic questions, validated measures (Shortened Warwick-Edinburgh Mental Wellbeing Scale, ICECAP-O, EQ-5D-3L, UCLA Loneliness Scale-3) and healthcare utilisation questions were conducted with participants at baseline (n = 273), three (n = 212) and six months (n = 182). These measures were selected and piloted by a project team, which includes older people and volunteers. Results Participants were mostly (63%) female and just over age were 75-85 years. Almost all (96%) had at least one chronic illness, 98% identified as white and 95% were not working. Participants had higher levels of loneliness, poorer wellbeing and health, and a higher frequency of primary care and acute service use compared to the general population. Participation with services was associated with improvements in capabilities, quality of life, and reduced loneliness - particularly with longer engagement. There were significant reductions in GP use at three months, and emergency hospital visits and use of unspecified community services at six months. Regression analysis found being male, having poorer baseline quality of life, and higher baseline costs were associated with higher six-month costs, while higher baseline loneliness was linked to lower costs, possibly due to reduced engagement with services among lonelier individuals. Conclusion A high level of need was observed among older people. Participation in ECC-supported services was associated with some improvements, which provides important evidence supporting the effectiveness of community-centred care coordination as part of the wider system.