Browsing by Subject "elderly"
Now showing items 1-14 of 14
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(2021)Tutkielman tarkoituksena on tutustua kirjallisuuteen koskien ikääntymiseen ja sen vaikutuksesta parodontiumiin ja suun terveyteen. Ikääntyneillä on useasti tekijöitä, jotka voivat lisätä riskiä parodontiitille. Lisäksi tutkielmassa käsitellään parodontiumin ja suun fysiologisia muutoksia ikääntyessä ja pohditaan niiden yhteyttä parodontiittiin. Ikääntymiseen liittyy monia erilaisia fysiologisia ja yleisterveydellisiä muutoksia. Näiden erilaisten tekijöiden tuntemisen ja tutkimisen tärkeys on kasvanut merkittävästi viime vuosikymmenien aikana väestön keski-iän noustessa. Yhä useampi ikääntynyt säilyttää hampaansa, kun vanhusväestön suun terveys on parantunut. Lisäksi hammasimplanttien omaavien määrä on kasvamassa. Nämä tekijät ovat johtaneet parodontaalisairauksien määrän kasvuun ikääntyneillä ja sen seurauksena tarve korkealaatuiseen suunterveydenhoitoon on lisääntynyt. Omien hampaiden säilyminen sekä implantit ikääntyneillä lisäävät elämänlaatua mutta hoitamattomina ne myös lisäävät riskiä erilaisille sairauksille. Parodontaali-infektiot ja hampaiden menetys lyhentävät elinikää ja heikentävät elämänlaatua. Suun sairauksilla on vaikutusta myös systeemisesti, kun bakteereita pääsee elimistöön verenkierron, aspiraation tai ruuansulatusjärjestelmän kautta.
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(2021)Tutkielman tarkoituksena on tutustua kirjallisuuteen koskien ikääntymiseen ja sen vaikutuksesta parodontiumiin ja suun terveyteen. Ikääntyneillä on useasti tekijöitä, jotka voivat lisätä riskiä parodontiitille. Lisäksi tutkielmassa käsitellään parodontiumin ja suun fysiologisia muutoksia ikääntyessä ja pohditaan niiden yhteyttä parodontiittiin. Ikääntymiseen liittyy monia erilaisia fysiologisia ja yleisterveydellisiä muutoksia. Näiden erilaisten tekijöiden tuntemisen ja tutkimisen tärkeys on kasvanut merkittävästi viime vuosikymmenien aikana väestön keski-iän noustessa. Yhä useampi ikääntynyt säilyttää hampaansa, kun vanhusväestön suun terveys on parantunut. Lisäksi hammasimplanttien omaavien määrä on kasvamassa. Nämä tekijät ovat johtaneet parodontaalisairauksien määrän kasvuun ikääntyneillä ja sen seurauksena tarve korkealaatuiseen suunterveydenhoitoon on lisääntynyt. Omien hampaiden säilyminen sekä implantit ikääntyneillä lisäävät elämänlaatua mutta hoitamattomina ne myös lisäävät riskiä erilaisille sairauksille. Parodontaali-infektiot ja hampaiden menetys lyhentävät elinikää ja heikentävät elämänlaatua. Suun sairauksilla on vaikutusta myös systeemisesti, kun bakteereita pääsee elimistöön verenkierron, aspiraation tai ruuansulatusjärjestelmän kautta.
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(2021)Background: Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital. Methods: This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and ≥75 years. We compared interventions defined by the median daily therapeutic intervention scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent association between age group, mortality and neurological outcome. Results: This study included a total of 1,285 patients, of which 212 (16%) were ≥75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24% of the patients in the elderly group and 47% of the patients in the younger group had a CPC of 1-2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 3.36, 95% CI:2.21-5.11, p < 0.001) and neurological outcome (multivariate OR = 3.27, 95% CI:2.12-5.03, p < 0.001). Conclusions: The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.
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(2021)Background: Cardiac arrest (CA) is a leading cause of death worldwide. As population ages, the need for research focusing on CA in elderly increases. This study investigated treatment intensity, 12-month neurological outcome, mortality and healthcare-associated costs for patients aged over 75 years treated for CA in an intensive care unit (ICU) of a tertiary hospital. Methods: This single-centre retrospective study included adult CA patients treated in a Finnish tertiary hospital’s ICU between 2005 and 2013. We stratified the study population into two age groups: <75 and ≥75 years. We compared interventions defined by the median daily therapeutic intervention scoring system (TISS-76) between the age groups to find differences in treatment intensity. We calculated cost-effectiveness by dividing the total one-year healthcare-associated costs of all patients by the number of survivors with a favourable neurological outcome. Favourable outcome was defined as a cerebral performance category (CPC) of 1–2 at 12 months after cardiac arrest. Logistic regression analysis was used to identify independent association between age group, mortality and neurological outcome. Results: This study included a total of 1,285 patients, of which 212 (16%) were ≥75 years of age. Treatment intensity was lower for the elderly compared to the younger group, with median TISS scores of 116 and 147, respectively (p < 0.001). The effective cost in euros for patients with a good one-year neurological outcome was €168,000 for the elderly and €120,000 for the younger group. At 12 months after CA 24% of the patients in the elderly group and 47% of the patients in the younger group had a CPC of 1-2 (p < 0.001). Age was an independent predictor of mortality (multivariate OR = 3.36, 95% CI:2.21-5.11, p < 0.001) and neurological outcome (multivariate OR = 3.27, 95% CI:2.12-5.03, p < 0.001). Conclusions: The elderly ICU-treated CA patients in this study had worse neurological outcomes, higher mortality and lower cost-effectiveness than younger patients. Further efforts are needed to recognize the tools for assessing which elderly patients benefit from a more aggressive treatment approach in order to improve the cost-effectiveness of post-CA management.
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(2015)Different kind of medication reviews have been developed in different countries. In Finland comprehensive medication review was developed in the late 2000th. Only few researches of medication review exist in Finland. In other countries more studies on the subject have been done. This Master's thesis's aim in the literature review was to examine what kind of outcome measurements were used in medication review studies and what kind of results were obtained from these measurements. In many medication review studies different kind of drug related parameters were used to evaluate the effectiveness of medication review. These parameters are Drug Related Problems (DRP), Medication Appropriateness Index (MAI) and different kind of criteria's for potentially inappropriate medication for elderly. Medication reviews have showed a positive effect on these parameters. To the health-related quality of life medication reviews have not shown any statistical effect. Physical performance meters have not been used a lot in medication review studies. And results have been controversial. Omahoitosuunnitelma 2100 (OMA21) research project, that examines the effectiveness of the comprehensive medication review in Finnish health care, could potentially due to its long follow-up time produce results also from the quality of life and physical performance instruments. In the Master's thesis's experimental part the aim was to evaluate unity of the medication reviews in OMA21 research project. For four intervention patients in the OMA21 research project parallel medication reviews were done. From these reviews were examined how many of the problems found in the reviews were the same with different reviewers. There was a lot of dispersion in the problems found in the reviews. Only 17.5 % of the 40 different problems found in the reviews were the same with all the reviewers. From 12 patients medication reviews drug related problems were categorized by PCNE classification V6.2. 69 drug related problems were found from the medication reviews. Most common problem was the treatment effectiveness (P1) (37.7 %). For the problems 92 potential causes were found and the most common of them was drug selection (C1) (39.1 %). The aim was also examine whether Evidence-Based Medicine electronic Decision Support (EBMeDS) tool, developed by Duodecim Medical Publications Ltd, could be useful in the OMA21 research project. It was shown that EBMeDS have limited advantage if patients' information has not been reported right in the electronic health records. Only 30 % of the examined drugs had indication. In the future if the patients' information was reported right in the electronic health records the EBMeDS tools could be useful help in medication reviews, because EBMeDS contains many electronic databases that are often used in medication reviews.P50O48
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(2019)The amount of informal caregiving has increased in Finland, with a growing emphasis on the older adults. Although the medication management process in informal caregiving has been studied and is known to have significant risks, research data focusing on the older adults is still limited. The aim of this study was to describe the medication management process of informal carers and care recipients of at least 65 years old. The aim was to identify medication errors and medication risks in the medication management process and to find out how the caregivers manage them. In addition, the study examined the informal carers and care recipients own development proposals to improve medication management process. A total of 21 volunteer informal carers and care recipients living in the Helsinki metropolitan area were recruited to this study. The study was conducted as a qualitative interview survey in the homes of the participants. The interviews were a combination of semi-structured interviews and narrative approach. The material to this study was collected during spring and summer 2018. The study was analysed with abductive content analysis combining both deductive and inductive approach. The aim was to find repetitive elements by encoding and grouping expressions. The results of this study were compared with previous theory and the results were supplemented with a picture of the medication management process and a fishbone diagram was drawn from the risk factors and contributing factors of the medication management process. The families had medication errors in all stages of the medication management process. The most frequent medication errors were found in counselling, medication administration and in medication treatment monitoring. As a contributing factor, the healthcare professionals’ haste and the responsibility of the caregiver recurred in the background of the medication errors. Family caregivers and care recipients wish to have more counselling, more monitoring of medication and better interaction with health care. Carers often felt left alone to take care of another person's medications and felt they lack support from healthcare. By facilitating access to a physician, improving the availability of a physician, increasing the amount of counseling and support provided by healthcare, including pharmacies, could the safety of medication management at home be improved.
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(2017)There are many challenges in use of dosage forms in medication of elderly people. Especially swallowing of solid dosage forms can be difficult. Dosage forms are often altered to enhance drug intake. Medication adherence is a major contributor to the success of therapy. Adherence is a multidimensional phenomenon which is also affected by properties of medicinal product. Theoretical framework of this thesis is World Health Organization's multidimensional adherence model. Only few studies exist on how properties of dosage forms affect to the success of medical treatment of elderly. The aim of this study was to find out what kind of difficulties related to dosage forms occur in medical treatment of elderly people living in nursing homes. Future goal is to develop dosage forms better suited to elderly and hence improve their medication adherence. This study consisted of interviews and e-survey. This study was carried out in six nursing homes where 322 elderly residents fulfilled the inclusion criteria of the study. Nurses (n = 48) were interviewed to explore their views on difficulties related to dosage forms. Other difficulties in use of dosage forms were also surveyed as well as frequency of tablet crushing. Difficulties in use of dosage forms on the medical treatment of the elderly were gathered in the e-survey. Also, the need to crush tablets and open capsules was surveyed as well as need to split tablets to obtain the dose needed. Difficulties in use of dosage forms are common in medical treatment of elderly people. Majority of the interviewed nurses has encountered these difficulties at least few times a week. The most common problematic dosage form was the tablet. About half of the nurses named the big size of tablets and capsules as the most important difficulty in the use of current oral or peroral dosage forms. Over half of the nurses have crushed or given crushed drug daily. The most common reason for dosage form altering was the big size of the medicinal product. Majority of the nurses has often encountered also other than dosage form related difficulties of which the most common challenges are related to suspiciousness. In e-survey, nurses submitted entries regarding 111 elder people. Most cases were related to splitting of a tablet to obtain the desired drug dose. Tablet crushing was reported for little less than one-fifth of the elderly people. Both the splitting and crushing entries were distributed over multiple different medicinal products. Some other difficulties related to dosage forms were reported for less than one-tenth of the elderly people. Based on this study more appropriate dosage forms should be developed for the medical treatment of elderly people. Oral solutions, orodispersible tablets as well as transdermal patches all have advantages. Pharmaceutical research and development can facilitate medical treatment of elderly people and hence improve their medication adherence by introducing more appropriate dosage forms.
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(2020)Mental problems are universal; they exist in Japan and in Finland. While there are cultural differences between a small Nordic country and a country with a particularly original culture, the similarities when understanding and dealing with them are more definitive. Both cultures have used harsh methods to deal with mental problems and stigmatised patients, and both have seen these methods and stigmas wither away. Japan has improved mental health care services as this is going to be one of their most prevalent health care concern in the future. The focus of this study is on aging persons’ mental health, because both Japan and Finland are aging rapidly. Caring for the mental health relies on aging individuals, their families, communities and health caregivers.
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(2023)This population-based registry study aimed to report 30-day and one-year postoperative survival, five-year overall survival (OS), and disease-specific survival (DSS) among elderly (≥75 years old) colorectal cancer (CRC) patients. All new colorectal cancer cases from 2006–2015 were included and followed until death or the end of follow-up (end of 2016). Among 27 088 CRC patients, 11 306 patients were ≥75 years old. Among patients ≥75 years, 36.8% (n = 4160) had right-sided colon cancer, 21.9% (n = 2478) left-sided colon cancer, and 32.3% (n = 3650) rectal cancer. In this study population, 932 patients were aged ≥90. The 30-day postoperative OS for patients aged 75–79 was 96.1% (95% confidence interval [CI] 95.3–96.9) falling to 93.2% (95% CI 92.0–94.4) for patients aged 80–84. The one-year postoperative OS among patients aged 75–79 was 86.3% (95% CI 84.7–87.9) compared with 80.5% (95% CI 78.7–82.3) among patients aged 80–84. Five-year OS among patients aged 75–79 was 47.6% (95% CI 46.0–49.2) and 36.6% (95% CI 34.8–38.4) among patients aged 80–84, compared with 61.7% (95% CI 60.9–62.5) among younger patients (<75 years old). Survival among elderly CRC patients (≥75 years old) was in general fairly good when compared with younger patients, especially among patients aged 75–79 and 80–84 with localized or locally advanced disease.
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(2023)This population-based registry study aimed to report 30-day and one-year postoperative survival, five-year overall survival (OS), and disease-specific survival (DSS) among elderly (≥75 years old) colorectal cancer (CRC) patients. All new colorectal cancer cases from 2006–2015 were included and followed until death or the end of follow-up (end of 2016). Among 27 088 CRC patients, 11 306 patients were ≥75 years old. Among patients ≥75 years, 36.8% (n = 4160) had right-sided colon cancer, 21.9% (n = 2478) left-sided colon cancer, and 32.3% (n = 3650) rectal cancer. In this study population, 932 patients were aged ≥90. The 30-day postoperative OS for patients aged 75–79 was 96.1% (95% confidence interval [CI] 95.3–96.9) falling to 93.2% (95% CI 92.0–94.4) for patients aged 80–84. The one-year postoperative OS among patients aged 75–79 was 86.3% (95% CI 84.7–87.9) compared with 80.5% (95% CI 78.7–82.3) among patients aged 80–84. Five-year OS among patients aged 75–79 was 47.6% (95% CI 46.0–49.2) and 36.6% (95% CI 34.8–38.4) among patients aged 80–84, compared with 61.7% (95% CI 60.9–62.5) among younger patients (<75 years old). Survival among elderly CRC patients (≥75 years old) was in general fairly good when compared with younger patients, especially among patients aged 75–79 and 80–84 with localized or locally advanced disease.
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(2017)The proportion of older adults has dramatically increased in developed countries due to longer life expectancy. The wellbeing of this group has large economic implications. Self-rated health (SRH) is a globally used method to measure both physical and psychosocial health and in some conditions considered as a better indicator than medical records. The main aim of this thesis was to study whether socioeconomic (SES) factors as well as nutritional intake are associated with physical and psychosocial SF-36 score change during a ten year period. Helsinki Birth Cohort Study (HBCS) consists of 8760 participants who were born at Helsinki University Central Hospital between 1934 and 1944. HBCS is a longitudinal study where data has been collected along the life span. In this thesis material was used from the baseline clinical visit (years 2001-2004) and the follow-up clinical visit (years 2011-2013). During the follow-up, 1094 participants (men n=478, women n=616) were traceable and took part in the follow-up visit which makes the participants 67 to 77 years old at that point. At the baseline clinical examination (n=2003), diet was assessed with a validated food-frequency questionnaire from which the Baltic Sea diet score (BSDS) was calculated. Higher scores indicated better adherence to the Baltic Sea diet. Self-rated psychosocial and physical wellbeing was assessed with the Short Form 36 scale (SF-36) in 2001-2004 and 2011-2013. The difference between baseline and follow-up SF-36 psychosocial and physical measurement was calculated. Socioeconomic indicators included degree of education, length of education and the average monthly taxable income. Men and women were studied separately. Also the group of those still in work life at baseline were evaluated separately from those who were already retired. Associations between BSDS and the SES factors were also tested. The statistical analysis program SPSS version 22 was used to calculate associations between the SES factors and BSDS with psychosocial and physical change. Linear regression method was used for the analyses. In addition, a comparison of the follow-up SF-36 scores according to socioeconomic factors were examined with ANOVA post hoc Tukey HSD test. Degree of education was positively associated with changes in psychosocial functioning at old age among men (p=0.009), whereas length of education associates positively among women (p=0.027). Both degree and length of education were positively associated with psychosocial functioning within the group that was still in work life at baseline. Change in physical functioning was not associated with SES or BSDS. Adherence to the BSD was not significantly associated with either of the SF-36 measurement factors but was related to higher income. Degree of education and length of education seem to indicate the direction of psychosocial functioning in early old age. Physical degeneration during late adulthood is normal and is less predictable by SES factors. BSDS did not predict physical or psychosocial wellbeing among this population but was positively associated with income among the participant.
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(2022)The restrictions due the COVID-19 -pandemic had a significant influence on everyday life throughout the society. Especially the elderly, who have a higher risk for severe coronavirus disease, were affected by strict restrictions. The elderly aged over 70 years were obligated to avoid all social contacts outside home. As a result, also in the services for older people, visits of relatives were forbidden and free time activities were ceased. The wellbeing of the elderly during these restrictions has received increasing interest in the academic field. This thesis focuses on the customers of Finnish services for older people. The thesis aims to describe life satisfaction and everyday activity of the elderly during the pandemic. Furthermore, in the context of the pandemic, the relationship of everyday activity and life satisfaction is examined. The thesis first examines the existing literature about life satisfaction and everyday activity of the elderly. Also, the effects of the coronavirus pandemic are discussed. The primary database of references used in the review was Google Scholar. The empirical study was conducted on survey data collected by Finnish Institute of Health and Welfare via VANKO-project. The participants were both the customers of the elderly services (n=7440), and providers of elderly services (n=2950). Everyday activity and life satisfaction were examined through descriptive statistics, and linear regression analysis was used to examine the relationship of everyday activity and life satisfaction. The analyses were conducted with IBM SPSS Statistics. The study found that life satisfaction of the customers of Finnish elderly services was moderately high despite the pandemic. Moreover, majority of the participants were satisfied with the possibilities of physical activity during the pandemic. Also, experiences of insufficient amounts of physical activity did not correlate with lower life satisfaction. The results are aligned with previous studies that have also reported only minor effects between the pandemic and the wellbeing of the elderly. The strength of the study is an extensive sample of the customers of elderly services in Finland. However, the results of this thesis are not applicable outside the specific examined population. As a result, further studies on the subject are needed.
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(2022)The restrictions due the COVID-19 -pandemic had a significant influence on everyday life throughout the society. Especially the elderly, who have a higher risk for severe coronavirus disease, were affected by strict restrictions. The elderly aged over 70 years were obligated to avoid all social contacts outside home. As a result, also in the services for older people, visits of relatives were forbidden and free time activities were ceased. The wellbeing of the elderly during these restrictions has received increasing interest in the academic field. This thesis focuses on the customers of Finnish services for older people. The thesis aims to describe life satisfaction and everyday activity of the elderly during the pandemic. Furthermore, in the context of the pandemic, the relationship of everyday activity and life satisfaction is examined. The thesis first examines the existing literature about life satisfaction and everyday activity of the elderly. Also, the effects of the coronavirus pandemic are discussed. The primary database of references used in the review was Google Scholar. The empirical study was conducted on survey data collected by Finnish Institute of Health and Welfare via VANKO-project. The participants were both the customers of the elderly services (n=7440), and providers of elderly services (n=2950). Everyday activity and life satisfaction were examined through descriptive statistics, and linear regression analysis was used to examine the relationship of everyday activity and life satisfaction. The analyses were conducted with IBM SPSS Statistics. The study found that life satisfaction of the customers of Finnish elderly services was moderately high despite the pandemic. Moreover, majority of the participants were satisfied with the possibilities of physical activity during the pandemic. Also, experiences of insufficient amounts of physical activity did not correlate with lower life satisfaction. The results are aligned with previous studies that have also reported only minor effects between the pandemic and the wellbeing of the elderly. The strength of the study is an extensive sample of the customers of elderly services in Finland. However, the results of this thesis are not applicable outside the specific examined population. As a result, further studies on the subject are needed.
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(2019)As the population becomes older and the amount of multimorbid patients increases, also health care spending increases. New care models are needed where patients’ needs are taken into consideration by providing preventive and patient-centred care. In Finland and internationally, new ways to treat elderly, chronically ill patients have been developed. One of the new models is the health and care plan model. This longitudinal, randomised, controlled trial studied the health and care plan model’s impact on healthcare costs, patients’ physical functioning and patients’ quality of life. The aim of the study was to study the cost-effectiveness of the health and care plan model compared to standard care practice. The goal of this study was to study if rational pharmacotherapy and self-management support can prevent the decline in physical functioning, the decline in quality of life and the increase in health service use and costs among elderly population. This study was conducted between 2014-2018 as a multi-disciplinary cooperation between Tornio health station, University of Helsinki Faculty of Pharmacy and Alatornio pharmacy. The patients in this study were over 75-year old, multimorbid, community dwelling, polypharmacy patients. The patients in the intervention group received an interview based clinical medication review and were formed a medication plan. Furthermore, the patients in the intervention group were planned a health and care plan that was combined with the medication plan into a comprehensive self-management plan in a multi-disciplinary meeting. A case manager was appointed for the patients in the intervention group and the case manager could be contacted by the patients in the intervention group at any point of the study if there arose a non-acute concern with the patient’s health. The patients in the control group were conducted a prescription review based on the information available in the electronic health records system and continued receiving the standard care practice. Cost and effectiveness data were gathered from the patients over the period of two years. The effectiveness data were gathered at Tornio health station where the intervention and control group’s quality of life was measured with the SF-36 generic quality of life measure and physical functioning was measured with Short Physical Performance Battery (SPPB). The quality of life data gathered with SF-36 were transformed into one preference based single index score SF-6D to calculate the quality of life and quality adjusted life years (QALY). Data about the use of health services were extracted from the electronic health records system and transformed into costs by using the national reference costs. At the beginning of the study, the intervention and control group were statistically significantly similar. During the two-year follow-up, no statistically or clinically significant differences were observed between the intervention and control group in their quality of life, in their physical functioning or in the costs of used health services. However, in the intervention group, the cost of used health services was on average 2 406 euros smaller than those of the control group’s during the two-year follow-up. The health and care plan model was cost-effective compared to standard care practice. The incremental cost-effectiveness ratio was -64 504 € per one QALY. Based on this study, it is recommended to support the self-management and physical functioning of the elderly with an intervention like health and care plan model to decrease the health care spending. The results of this study can be applied to Finnish healthcare system to decrease the health care spending of multimorbid, community dwelling and polypharmacy elderly patients. The use of real-world evidence increases the reliability of this study.
Now showing items 1-14 of 14