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Long-Term Care for Older Adults: Future Research Needs
Future Research Needs Papers, No. 44
Investigators: Andrea Wysocki, MPP, Mary Butler, PhD, MBA, Robert L Kane, MD, and Tetyana Shippee, PhD.
Author Information and AffiliationsStructured Abstract
Objectives:
To identify gaps in the current research on long-term care (LTC) for older adults that limited the conclusions of the comparative effectiveness review (CER) “Long-Term Care for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care” in order to inform those who conduct and fund research about the research needs on this topic.
Methods:
We used a deliberative process to identify specific research needs and research design considerations. We refined a list of evidence gaps from the CER and recruited a diverse stakeholder panel to supplement this list of gaps. Based on stakeholder feedback about the current policy environment and consumer preference for home and community-based services (HCBS), we developed two sets of research questions and separated each set into methodological questions and topical questions. The first set addressed the topic of the CER, which was the comparison of LTC for older adults delivered through HCBS and in nursing homes (NHs). The second set addressed broader LTC issues that stakeholders raised as salient for the current policy environment; this set framed questions about these settings and services separately rather than as a comparison. We sent both sets of research questions to stakeholders to rank by priority, and we calculated unweighted and weighted scores based on their rankings. We identified breakpoints in the weighted rankings that separated high- and moderate-/low-priority research questions. Highly prioritized research questions were considered research needs. We discussed research design considerations for research needs.
Results:
Of 13 stakeholders invited to participate, 10 completed the ranking exercise. Among the methodological questions for the comparison of LTC delivered through HCBS and in NHs, the identification of standardized outcome measures for HCBS and NH recipients was the highest priority. For the broader set of methodological questions about LTC through HCBS and in NHs, the highest rankings were given to four questions related to outcome measures and descriptions of the interventions. For the topical questions for the comparison of LTC delivered through HCBS and in NHs, the highest rankings were given to questions related to the pattern of transitions for LTC uses, and the factors leading to transitions. We also identified four high-priority topical questions primarily related to the populations that benefit most from interventions and the types of interventions that lead to improved outcomes. Future studies on LTC for older adults should aim to reduce bias as much as possible through research design and statistical techniques. Larger sample sizes will allow more research on subpopulations, and longer followup times will allow a better understanding of how interventions may modify outcomes over time.
Conclusions:
The clinical and policy context of LTC is changing. Comparative effectiveness may be less salient than understanding what makes such care effective in the first place for various client groups. Therefore, we reported research needs related to the comparison of HCBS and NH care that was the focus of the CER, and we also reported research needs from the broader set of questions that stakeholders deemed important within the current policy environment. Future research in this area will create a broader and stronger evidence base for making care and policy decisions.
Contents
- Preface
- Contributors
- Executive Summary
- Background
- Methods
- Results
- Discussion
- Conclusions
- References
- Abbreviations
- Appendix A Selection Criteria for New Research: Long-Term Care for Older Adults Research Needs
- Appendix B Minnesota Evidence-based Practice Center (MN EPC) Long-Term Care for Older Adults Research Needs Project: Stakeholder Conference Call Information
- Appendix C Minnesota EPC Long-Term Care for Older Adults Research Needs Stakeholder Meeting Agenda
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10064-I Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, MN
Suggested citation:
Wysocki A, Butler M, Kane RL, Shippee T. Future Research Needs: Long-Term Care for Older Adults. Future Research Needs Paper No. 44. (Prepared by the University of Minnesota Evidence-based Practice Center under Contract No. 290-2007-10064-I). AHRQ Publication No.13-EHC120-EF. Rockville, MD: Agency for Healthcare Research and Quality; July 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10064-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
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