Effects of utilization of case management related services on the quality of life of the community-based long-term care population.

摘要

The purpose of this study is two fold: (a) validation of two measurement models that delineate the concepts of quality of life of the frail elderly and use of case- managed, community-based services and (b) examination of the impact of case-managed, community-based services on the quality of life of the frail elderly, using cross-sectional and longitudinal analyses.; Quality of life of the frail elderly was measured by three latent constructs (poor health, unmet need for functional assistance, and social-psychological well-being). Three types of services (use of formal in-home services, meal delivery, and transportation) were used to measure use of case-managed, community-based services.; Structural equation models for the cross-sectional and longitudinal analyses were estimated to examine the relationship of use of case-managed, community-based services to the quality of life of the frail elderly. In the cross-sectional analysis, use of formal in-home services had statistically significant relationships with the three dimensions of quality of life. This suggests that those who use more formal in-home services have poorer health, lower unmet need for functional assistance, and lower social-psychological well-being. Use of meal delivery had positive and significant relationships with two dimensions of quality of life. This suggests that those who use home delivered meals have higher unmet need for functional assistance and higher social-psychological well-being.; In the panel model, only poor health at time 2 was negatively and significantly affected by use of formal in-home services at time 1. This finding suggests that over time use of formal in-home services has a low, direct impact on poor health. Thus, the greater the use of formal in-home services, the better the health rating over time.; It is suggested that the measurement of health status and quality of life is increasingly important since, in general, the elderly suffer from multiple chronic illnesses that are unlikely to be cured by clinical interventions. Instead, especially for the frail elderly, improvements in the quality of life are possible. It also has been recognized that universally accepted definition, dimensions, and measures of quality of life of the frail elderly would be useful to long term care policy makers and planners in order to modify existing programs or in the further development of effective community-based services to improve the quality of life of the frail elderly.