Using a common framework and language, we hoped to ensure that high risk older adults would be appropriately identified in order that we could offer personalized care plans across home care and long-term care (LTC).
We are proposed a series of targeted interventions for older adults across the continuum of home care and LTC. We conducted a multi-phased mixed-methods evaluation (quantitative observational, qualitative and pragmatic experimental evaluations) of three linked implementation projects. Each project was evidence-informed, based on tested implementation strategies, and supported by local decision makers. We implemented our interventions on existing common models of assessment and care that responded to risk of adverse outcomes in older persons living with frailty in home care and LTC.
The three large-scale projects in this research program served as an important precedent for co-innovation with knowledge users and paved the way towards greater health system integration for older adults living with frailty. Each project in our program is scalable because they make use of adapted and available evidence-informed interventions, standardized widely used risk assessments and secondary data. In the future, other comparable projects could easily be implemented using our approach.
John Hirdes, PhD is a Professor in the School of Public Health and Health Systems, University of Waterloo. He is the senior Canadian Fellow and a Board Member of interRAI, an international consortium of researchers from over 30 countries. He chairs interRAI’s Network for Mental Health and the interRAI Network of Canada. He is also a Fellow of the Canadian Academy of Health Sciences.
Dr. Hirdes has over 200 publications in peer reviewed journals and academic book chapters. His primary areas of interest include assessment, mental health, aging, health care and service delivery, case mix systems, quality measurement, health information management, and quantitative research methods.
In 2012, Dr. Hirdes received the Queen Elizabeth II Diamond Jubilee Medal for his work on long term care through the Canadian Home Care Association and the Canadian Association on Gerontology.