Thailand trials new model of care for older adults

As part of a trial funded by the World Health Organization, researchers in Thailand have implemented a new model of care for older adults to ease the burden on families.

The community-integrated intermediary care (CIIC) model is specially adapted for improving health and social care services in Association of Southeast Asian Nations (ASEAN) countries. The CIIC model is a novel approach for improving access to long-term care service for the aging population. It recruits community services to offer support to the older people, reducing the pressure on family caregivers.

This care service has proven effective in reducing caregiver burden and improving the functional ability and independence of seniors. The multi-pronged model includes care prevention activities, capacity-building for family caregivers and community respite services.

A multinational group of researchers from Chiang Mai Rajabhat University, Thailand; Tokyo Ariake University of Medical and Health Sciences, Japan; Ministry of Public Health, Thailand; Chulalongkorn University, Thailand; and Juntendo University, Japan have collaboratively proposed the new prevention-based, community-integrated care model.

The model was implemented in Chiang Mai, Thailand and its effectiveness was tested through a cluster-randomised controlled trial funded by the World Health Organization Centre for Health Development (WHO Kobe Centre). The results of this trial are collated in a study published in Health Research Policy and Systems.

A total of 2788 participants — 1509 in CIIC intervention clusters and 1279 in control clusters (which had traditional family-based care) — were recruited for the trial. The study investigated the effectiveness of the CIIC model in reducing the burden on family caregivers and improving older people’s functional ability and quality of life.

The CIIC model combines formal and informal care that can be implemented at a community, district, subdistrict or city level. It is designed to improve the link between families and communities, and local formal health services and funding by using a multi-tiered collaborative approach.

“The CIIC model includes older persons, their families, peer groups, volunteers, community stakeholders, local governments, primary healthcare centres and public health departments and ministries in Thailand, for more streamlined resource mobilisation and sustainable finance,” explained Professor Myo Nyein Aung from Juntendo University, the lead researcher of the trial.

The CIIC intervention included three components. The first was encouraging community group exercises and home exercises to preserve the functional ability of the older persons and reduce their care needs and frailty; the second was the delivery of technical training and assistance for family caregivers to improve their care capacity; and the third component was the provision of formal care through a community-level, short-term respite care service centre for dependent elders when their family caregivers are temporarily unavailable.

At a six-month follow-up, it was found that more families showed reduced caregiver burden in the intervention clusters (mean = 39.4%) than control clusters (mean = 28.62%). Similarly, there were more participants in the intervention clusters (mean = 83% and 87.14%) than the control clusters (mean = 78% and 85.89%) without functional decline and depression, respectively.

These results indicate the potential effectiveness of the CIIC model in preventing an increase in long-term care needs by improving the physical and mental capacities of elders and in reducing the burden of family caregivers through adequate support.

“CIIC is a cost-effective care model that can be scaled up to help actualise universal long-term care coverage, particularly for the aging populations across different countries in Asia, as well as globally. Furthermore, it could play a key role in bettering health and social welfare policies,” Aung said.

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