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The impact of a preventive health care program for older people on health status, knowledge and costs Pickard, Lynette Elizabeth

Abstract

The purpose of this study was to test the claim that senior citizens who received preventive nursing services which were accessible and emphasized health promotion (through health education, counselling and early detection of disease) would have significantly lower health costs and significantly greater health status, knowledge and behaviour than those who received nursing services which were less accessible and placed less emphasis on health promotion. Residents of two apartment complexes for senior citizens in the West End of Vancouver (Nicholson and Sunset Towers) were participants in this study. The main differences between the nursing programs in these two complexes are the increased accessibility of the nurses in Nicholson Towers and the greater amount of health education and counselling which is done there. A sample of individuals from each complex was randomly selected for interviewing. Data collected from residents in a structured interview measured health knowledge, health behaviour, health status and variables identified in the literature as related to health knowledge and health status. The Medical Services Plan of B.C. and Pharmacare supplied data on number and cost of health services and cost of medication for individuals in the study over an eight month period. Data were computer analyzed using the University of British Columbia's version of SPSS. Results of the study indicated that average health costs were not significantly lower in the building in which preventive nursing services were available. Possible reasons for this unexpected finding are that Home Care nursing services are costly, that increased accessibility of Home Care nursing services leads to increased utilization and increased costs, that the ability to bring about improvement in health is limited by the aging process and that we may have unrealistic expectations of prevention programs. Residents of Nicholson Towers (who received preventive nursing services) were found to have significantly greater physical and social function than those in Sunset Towers (who did not receive preventive nursing services). Eligibility for Long Term Care accounts for a large percentage of variance in physical function and Nicholson Towers has a significantly (34% vs. 39%) smaller percentage of residents eligible for Long Term Care. This could account for the significantly greater physical function of residents in this complex. The social function scale evidenced low (.43) alpha reliability and low content and convergent validity. Findings regarding the significant differences between the complexes in terms of social function are therefore tenuous. Findings regarding health education in both complexes support the conclusion that there could be greater use of group methods and techniques of instruction. This is likely to increase both the effectiveness and efficiency of health education.

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