 |
|
A Randomized Trial of In-Home Visits for Disability Prevention in Community-Dwelling Older People at Low and High Risk for Nursing Home Admission
Andreas E. Stuck, MD;
Christoph E. Minder, PhD;
Iris Peter-Wüest, RN;
Gerhard Gillmann;
Claude Egli;
Annemarie Kesselring, PhD;
Robert E. Leu, PhD;
John C. Beck, MD
Arch Intern Med. 2000;160:977-986.
Background In-home preventive visits with multidimensional geriatric assessments can delay the onset of disabilities in older people.
Methods This was a stratified randomized trial. There were 791 participants, community-dwelling people in Bern, Switzerland, older than 75 years. The participants' risk status was based on 6 baseline predictors of functional deterioration. The intervention consisted of annual multidimensional assessments and quarterly follow-up in-home visits by 3 public health nurses (nurses A, B, and C), who, in collaboration with geriatricians, evaluated problems, gave recommendations, facilitated adherence with recommendations, and provided health education. Each nurse was responsible for conducting the home visits in 1 ZIP code area.
Results After 3 years, surviving participants at low baseline risk in the intervention group were less dependent in instrumental activities of daily living (ADL) compared with controls (odds ratio, 0.6; 95% confidence interval, 0.3-1.0; P=.04). Among subjects at high baseline risk, there were no favorable intervention effects on ADL and an unfavorable increase in nursing home admissions (P=.02). Despite the similar health status of subjects, nurse C identified fewer problems in the subjects who were visited compared with those assessed by nurses A and B. Subgroup analysis revealed that among low-risk subjects visited by nurses A and B, the intervention had favorable effects on instrumental ADL (P=.005) and basic ADL (P=.009), reduced nursing home admissions (P=.004), and resulted in net cost savings in the third year (US $1403 per person per year). Among low-risk subjects visited by nurse C, the intervention had no favorable effects.
Conclusions These data suggest that this intervention can reduce disabilities among elderly people at low risk but not among those at high risk for functional impairment, and that these effects are likely related to the home visitor's performance in conducting the visits.
From the Geriatric Research Unit, Department of Geriatrics and Rehabilitation, Zieglerspital (Dr Stuck and Ms Peter-Wüest), the Division of Biostatistics, Department of Social and Preventive Medicine (Dr Minder and Messrs Gillmann and Egli), and the Economics Institute (Dr Leu), University of Bern, and the Swiss Institute for Nursing Research (Dr Kesselring), Bern, Switzerland; and the School of Medicine, University of California, Los Angeles (Dr Beck).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
A randomized controlled trial of telephone-supported care coordination in patients with congestive heart failure
Wootton et al.
J Telemed Telecare 2009;15:182-186.
ABSTRACT
| FULL TEXT
Review: Review of Nurse Home Visiting Interventions for Community-Dwelling Older Persons With Existing Disability
Liebel et al.
Med Care Res Rev 2009;66:119-146.
ABSTRACT
Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study
Piccoliori et al.
Age Ageing 2008;37:647-652.
ABSTRACT
| FULL TEXT
Promotion of health in older people: a randomised controlled trial of health risk appraisal in British general practice
Harari et al.
Age Ageing 2008;37:565-571.
ABSTRACT
| FULL TEXT
Multidimensional Geriatric Assessment: Back to the Future Cost-Effectiveness of a Multidisciplinary Intervention Model for Community-Dwelling Frail Older People
Melis et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:275-282.
ABSTRACT
| FULL TEXT
Multidimensional Geriatric Assessment: Back to the Future Effects on Health Care Use and Associated Cost of a Home Visiting Program for Older People With Poor Health Status: A Randomized Clinical Trial in the Netherlands
Bouman et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:291-297.
ABSTRACT
| FULL TEXT
Multidimensional Geriatric Assessment: Back to the Future Multidimensional Preventive Home Visit Programs for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Huss et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:298-307.
ABSTRACT
| FULL TEXT
The Effectiveness and Efficiency of Home-Based Nursing Health Promotion for Older People: A Review of the Literature
Markle-Reid et al.
Med Care Res Rev 2006;63:531-569.
ABSTRACT
Randomized controlled trials involving multidisciplinary interventions in the community.
Pahor
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2006;61:472-473.
ABSTRACT
| FULL TEXT
Life on the Edge: Patterns of Formal and Informal Help to Older Adults in the United States and Sweden
Davey et al.
Journals of Gerontology Series B: Psychological Sciences and Social Science 2005;60:S281-S288.
ABSTRACT
| FULL TEXT
Outcomes of Preventive Case Management Among High-Risk Elderly in Three Medical Groups: A Randomized Clinical Trial
Newcomer et al.
Eval Health Prof 2004;27:323-348.
ABSTRACT
Major Depression in Elderly Home Health Care Patients
Bruce et al.
Am. J. Psychiatry 2002;159:1367-1374.
ABSTRACT
| FULL TEXT
Subgroups of Refusers in a Disability Prevention Trial in Older Adults: Baseline and Follow-Up Analysis
Minder et al.
AJPH 2002;92:445-450.
ABSTRACT
| FULL TEXT
Home Visits to Prevent Nursing Home Admission and Functional Decline in Elderly People: Systematic Review and Meta-regression Analysis
Stuck et al.
JAMA 2002;287:1022-1028.
ABSTRACT
| FULL TEXT
Commentary: Disentangling the black box of disability prevention in older people
Stuck
Int J Epidemiol 2001;30:1491-1492.
FULL TEXT
Effectiveness of home based support for older people: systematic review and meta-analysis Commentary: When, where, and why do preventive home visits work?
Elkan et al.
BMJ 2001;323:719-719.
ABSTRACT
| FULL TEXT
Preventing disability and death in old age
Stuck and Beck
Int J Epidemiol 2001;30:900-901.
FULL TEXT
Other articles noted
Evid. Based Nurs. 2000;3:106-112.
FULL TEXT
Preventive home visits to elderly people in the community
Newbury et al.
BMJ 2000;321:512-512.
FULL TEXT
|
