The assessment of services promoting independence and recovery in elders trial (ASPIRE): A pre-planned meta-analysis of three independent randomised controlled trial evaluations of ageing in place initiatives in New Zealand

Introduction: Intermediate care has been developed to support older people to remain living in their own homes, combining a higher level of support with a rehabilitation focus. Evidence around their effectiveness remains mixed and there is ambiguity around the components. Aims: To establish the impact of intermediate care on institutional free survival in frail older people referred for needs assessment in New Zealand (NZ).Methods: pre-planned meta-analysis of three randomised controlled trials with follow-up at 3, 6, 12, 18 and 24 months. A total of 567 older people at risk of permanent institutionalisation as well as their primary informal carer (n = 234) were randomised to either intermediate or usual care. Interventions had common key features of care management, though varied in the use of ongoing care provision. Results: The adjusted hazard ratio for the combined primary outcome of death or residential entry was 31% lower with a 95% confidence interval of (9%, 47%) for the intermediate care initiatives compared with usual care. Conclusion: Intermediate care utilising a care management approach reduces a frail older person's risk of mortality and permanent institutionalisation.