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The global population of elderly people is increasing both in
developed and developing countries. According to the United Nations
estimates, the population of elderly in the world will reach 1.2 billion
by the year 20251, and the demand for medical and social services for the
elderly will be remarkable in near future2,3. A quest for the provision of
care in underserved communities is vital for the health and well-being of
older adults. At present, geriatric care is provided in hospitals, nursing
homes and community-based care settings (i.e. adult foster care homes,
residential care facilities, domiciliary care homes, board and care homes,
or assisted living facilities etc.).
Community-based care services are the wide variety of out-of-
hospital, non-medical community-based residential facilities that provide
living arrangements, meals and protective oversight4. The aims of such
services for elderly are5 to: keep older people at home, promote
independence, strengthen primary health and community services, and
strengthen voluntary and neighborhood support. The residents of community-
based care facilities are typically adults in need of a protective
environment because of physical or mental health problems in combination
with other risk factors such as advanced age, lack of family support and
low income. Adequate care is necessary to meet the needs of older adults
who can no longer function independently, yet do not require placement in
nursing homes. Community-based care offers many advantages: the comfort of
being in one’s own home, familiar cuisine; least disruption of normal
relationship; safety: lower infection rate (cross-infection), fewer
adverse events, less opportunity for iaterogenic complications, avoidance
of complications of bedsore; and maintenance of autonomy and independence.
Community-based care provides an important component of the long-term
care continuum between independent living and nursing homes6. The
following are the important arguments in favor of providing care to the
older people in their own homes or other community-based settings:
demographic2 and epidemiological3 trends, shortage of health personnel7,
lack of financial resources8, relatives take the role of informal
caregivers, reduce hospitalization9,10, increase quality of life11-18 and
improve user satisfaction19.
Although the need for alternatives to hospitals and nursing homes is
growing, little is known about the quality and efficacy of alternatives
such as community-based care facilities. There is a growing concern about
the health and quality of life of residents in such facilities. Monitoring
and guidelines are to be developed to ensure effective care. Community-
based geriatric medicine are to developed as a separate discipline to
produce community-based family physicians and health personnel for
geriatric care, who would able to provide services to the elderly in the
community-based health care facilities20.
1. Sen K, Kalache A, Coombs Y. Ageing, health, social change and policy in
developing countries. PHP Departmental Publication No. 9. London: London
School of hygiene and Tropical Medicine, 1993.
3. WHO. Report of the workshop on curricular changes to meet the health
needs of the elderly; 1986 8-10 July; Kula Lumpur, Malaysia. Manila: World
Health Organization, 1986.
4. United States General Accounting Office. Board and Care: Insufficient
Assurances that Residents' Needs are Identified and Met. (GAO/HRD-89-50
Board and Care Issues). Washington, DC: United States General Accounting
Office, 1989.
5. Iliffe S. Patterson L, Gould MM. Health Care for Older People. London:
BMJ Books, 1998.
6. Reschovsky JD, Ruchlin HS. Quality of board and care homes serving low-
income elderly: structural and public policy correlations. J Appl Gerontol
1993;12:225-45.
7. Barton LJ. A shoulder to lean on: assisted living in the U.S. Am
Demographics 1997;July:45-51.
8. Quinn ME, Johnson MA, Andress EL, McGinnis P, Ramesh M. Health
characteristics of elderly personal care home residents. J Adv Nurs
1999;30:410-7.
9. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med
1993; 118: 219-23.
10. Hoenig HM, Rubenstein LZ. Hospital-associated deconditioning and
dysfunction (Editorial). J Am Geriatr Soc 1991;39:220-2.
11. Wema K, Kihlgren M, Fagerberg I. Older people living in nursing homes
or other community care facilities: Registered Nurses' views of their
working situation and co-operation with family members. J Clin Nurs 2004;
13: 617–26
12. Stuck AE, Aronow, HU, Steiner A, Alessi CA, Bula CJ, Gold MN, Yuhas
KE, Nisenbaum R, Rubenstein LZ, Beck JC. A Trial of Annual In-Home
Comprehensive Geriatric Assessments for Elderly People Living in the
Community. N Engl J Med 1995;333:1184-9.
13. Vetter NJ, Jones DA, Victor CR. Effect of health visitors working with
elderly patients in general practice: a randomized controlled trial. BMJ
1984;288:369-72.
14. Hendriksen C, Lund E, Stromgard E. Consequences of assessment and
intervention among elderly people: a three year randomized controlled
trial. BMJ 1984;289:1522-4.
15. Carpenter GI, Demopoulos GR. Screening the elderly in the community:
controlled trial of dependency surveillance using a questionnaire
administered by volunteers. BMJ 1990;300:1253-6.
16. McEwan RT, Davison N, Forster DP, Pearson P, Stirling E. Screening
elderly people in primary care: a randomized controlled trial. Br J Gen
Pract 1990;40:94-7.
17. Pathy MS, Bayer AJ, Harding K, Dibble A. Randomized trial of case
finding and surveillance of elderly people at home. Lancet 1992;340:890-3
18. Vetter NJ, Lewis PA, Ford D. Can health visitors prevent fractures in
elderly people? BMJ 1992;304:888-90.
Congratulations to John Green and colleagues for this study.
It would be nice if they could extend this study to Home care Vs
Community hospital care. It would also be beneficial to know how many, if
any, had died in the intensive care units of the District General
Hospitals of nosocomial pneumonias, unconnected to their original disease!
Community-based care for elderly – needs more attention!
The global population of elderly people is increasing both in
developed and developing countries. According to the United Nations
estimates, the population of elderly in the world will reach 1.2 billion
by the year 20251, and the demand for medical and social services for the
elderly will be remarkable in near future2,3. A quest for the provision of
care in underserved communities is vital for the health and well-being of
older adults. At present, geriatric care is provided in hospitals, nursing
homes and community-based care settings (i.e. adult foster care homes,
residential care facilities, domiciliary care homes, board and care homes,
or assisted living facilities etc.).
Community-based care services are the wide variety of out-of-
hospital, non-medical community-based residential facilities that provide
living arrangements, meals and protective oversight4. The aims of such
services for elderly are5 to: keep older people at home, promote
independence, strengthen primary health and community services, and
strengthen voluntary and neighborhood support. The residents of community-
based care facilities are typically adults in need of a protective
environment because of physical or mental health problems in combination
with other risk factors such as advanced age, lack of family support and
low income. Adequate care is necessary to meet the needs of older adults
who can no longer function independently, yet do not require placement in
nursing homes. Community-based care offers many advantages: the comfort of
being in one’s own home, familiar cuisine; least disruption of normal
relationship; safety: lower infection rate (cross-infection), fewer
adverse events, less opportunity for iaterogenic complications, avoidance
of complications of bedsore; and maintenance of autonomy and independence.
Community-based care provides an important component of the long-term
care continuum between independent living and nursing homes6. The
following are the important arguments in favor of providing care to the
older people in their own homes or other community-based settings:
demographic2 and epidemiological3 trends, shortage of health personnel7,
lack of financial resources8, relatives take the role of informal
caregivers, reduce hospitalization9,10, increase quality of life11-18 and
improve user satisfaction19.
Although the need for alternatives to hospitals and nursing homes is
growing, little is known about the quality and efficacy of alternatives
such as community-based care facilities. There is a growing concern about
the health and quality of life of residents in such facilities. Monitoring
and guidelines are to be developed to ensure effective care. Community-
based geriatric medicine are to developed as a separate discipline to
produce community-based family physicians and health personnel for
geriatric care, who would able to provide services to the elderly in the
community-based health care facilities20.
E-mail: A.A.Majumder@bradford.ac.uk
References
1. Sen K, Kalache A, Coombs Y. Ageing, health, social change and policy in
developing countries. PHP Departmental Publication No. 9. London: London
School of hygiene and Tropical Medicine, 1993.
2. Forciea MN, Lavizzo-Mourey R, Schwab EP. Geriatric Secrets.
Philadelphia: Hanley & Belfus, inc., 2000.
3. WHO. Report of the workshop on curricular changes to meet the health
needs of the elderly; 1986 8-10 July; Kula Lumpur, Malaysia. Manila: World
Health Organization, 1986.
4. United States General Accounting Office. Board and Care: Insufficient
Assurances that Residents' Needs are Identified and Met. (GAO/HRD-89-50
Board and Care Issues). Washington, DC: United States General Accounting
Office, 1989.
5. Iliffe S. Patterson L, Gould MM. Health Care for Older People. London:
BMJ Books, 1998.
6. Reschovsky JD, Ruchlin HS. Quality of board and care homes serving low-
income elderly: structural and public policy correlations. J Appl Gerontol
1993;12:225-45.
7. Barton LJ. A shoulder to lean on: assisted living in the U.S. Am
Demographics 1997;July:45-51.
8. Quinn ME, Johnson MA, Andress EL, McGinnis P, Ramesh M. Health
characteristics of elderly personal care home residents. J Adv Nurs
1999;30:410-7.
9. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med
1993; 118: 219-23.
10. Hoenig HM, Rubenstein LZ. Hospital-associated deconditioning and
dysfunction (Editorial). J Am Geriatr Soc 1991;39:220-2.
11. Wema K, Kihlgren M, Fagerberg I. Older people living in nursing homes
or other community care facilities: Registered Nurses' views of their
working situation and co-operation with family members. J Clin Nurs 2004;
13: 617–26
12. Stuck AE, Aronow, HU, Steiner A, Alessi CA, Bula CJ, Gold MN, Yuhas
KE, Nisenbaum R, Rubenstein LZ, Beck JC. A Trial of Annual In-Home
Comprehensive Geriatric Assessments for Elderly People Living in the
Community. N Engl J Med 1995;333:1184-9.
13. Vetter NJ, Jones DA, Victor CR. Effect of health visitors working with
elderly patients in general practice: a randomized controlled trial. BMJ
1984;288:369-72.
14. Hendriksen C, Lund E, Stromgard E. Consequences of assessment and
intervention among elderly people: a three year randomized controlled
trial. BMJ 1984;289:1522-4.
15. Carpenter GI, Demopoulos GR. Screening the elderly in the community:
controlled trial of dependency surveillance using a questionnaire
administered by volunteers. BMJ 1990;300:1253-6.
16. McEwan RT, Davison N, Forster DP, Pearson P, Stirling E. Screening
elderly people in primary care: a randomized controlled trial. Br J Gen
Pract 1990;40:94-7.
17. Pathy MS, Bayer AJ, Harding K, Dibble A. Randomized trial of case
finding and surveillance of elderly people at home. Lancet 1992;340:890-3
18. Vetter NJ, Lewis PA, Ford D. Can health visitors prevent fractures in
elderly people? BMJ 1992;304:888-90.
19. Davies B, Fernández JL. Evaluating Community Care for Elderly People.
Available at URL: http://www.pssru.ac.uk/pdf/B14/B14Davies1.pdf. Access
on: 19 August 2005.
20. Majumder MAA, Rahim FA, Rahman S. Geriatric training in problem-based:
an Asian perspective. J Am Geriatr Soc 2004:52:1038-9.
Competing interests:
None declared
Competing interests: No competing interests