Authors: Jotheeswaran AT , Amit Dias, Ian Philp, John Beard, Vikram Patel, Martin Prince
Among older people, impairments in mobility, nutrition, vision, hearing, cognition, mood, and behaviour make an important contribution to years lived with disability, and dependence, and mortality. A recent systematic review concluded that, in primary care and community settings, interventions targeting risk factors and functional impairments may be more effective than disease specific interventions at alleviating burden in older people with complex multimorbidity. Such an approach may be particularly salient to low and middle- income countries with few physicians, where non-specialist community health workers could be used to improve the coverage of and access to health and social care. However, identifying impairments that limit older people’s functional capacity, and selecting and implementing evidence-based interventions will be a significant challenge in such settings.
The authors have already demonstrated that, after a 3 hour training, CHWs working in the Goa State health service could accurately identify frail, dependent, or frail and dependent older people.
The aims of the current study were therefore to develop a comprehensive assessment tool for CHWs working in the primary health care system, to assess the feasibility and acceptability of this approach, and to explore concurrent validity against clinical assessments carried out by physicians working in the same local public health system. It would not be appropriate to consider such assessments as a ‘gold standard’ criterion, since these doctors were non-specialists, and lacked the time or equipment for a rigorous comprehensive clinical examination. The approach was, rather, to assess pragmatically whether those identified by the CHWs would be likely to be confirmed as requiring intervention by local clinicians.
Resource Type: Research