Effects of a preventive home visit program in ambulatory frail older people: a randomized controlled trial.

BACKGROUND: The aim of this study was to examine the effects on functional and psychosocial parameters and long-term care utilization of a preventive home visit program for ambulatory frail Japanese elders. METHODS: Eligible participants (n = 323) were randomly assigned to intervention (n = 161) or control group (n = 162). Nurses and care managers provided structured preventive home visits to the intervention group participants every 6 months over 2 years. Activities of daily living (ADLs), instrumental activities of daily living (IADLs), depression, and social support were collected via mail questionnaire at baseline and at 12- and 24-month follow-up points. The utilization of long-term care insurance was documented over the period. RESULTS: Two-way analysis of covariance did not show significant outcome differences overall. In a pre-planned subgroup analysis for participants who had at least one ADL dependency at baseline, those in the intervention group (N = 105) were significantly less likely to deteriorate over 2 years in their function and depression than those in the control group (N = 100): ADLs (p = .0311), IADLs (p = .0114), depression (p = .0001). The total long-term care costs over 2 years in the intervention group (36,001 credits) were higher than in the control group (26,022 credits) (nonsignificant), and elders in the intervention group utilized significantly more community and institutional long-term care services than those in the control group over the period 7 months to 15 months after the intervention started. CONCLUSIONS: The results suggest that a preventive home visit program might be ineffective on functional and psychosocial status among ambulatory frail elders overall, although it might significantly improve ADLs, IADLs and depression for those with ADL dependency.

Preventive home visit model targeted to specific care needs of ambulatory frail elders: preliminary report of a randomized trial design.

AIM: The aim of this article is to describe the program and study design of our preventive home visit model that targets the specific care needs of Japanese ambulatory frail elders living at home. METHODS: The program focused on ambulatory frail elders who were certified as being in the two lowest levels of care need in the Long-Term Care Insurance system and eligible for care, but who were currently not using long-term care services. To provide efficient community- based preventive care, we developed a program model composed of structured assessments and individualized care recommendations conducted by community care nurses or workers. The assessment protocol focused on locomotion, activities of daily living, social activities, health status, and possibility of abuse. Care needs were clarified every six months over two years. The effectiveness of the program is being assessed in a randomized controlled trial. RESULTS: A total of 243 elders were assigned randomly to the preventive home-visit intervention (n=122) or control group (n=121). Their mean age was 80 years, 76% were women, and 25% lived alone. Outcomes including ADLs, IADLs, depression, and social support were measured by postal questionnaire at baseline, and at 12- and 24-month follow-ups. Utilization of public health or long-term care insurance and service uses over the period is also being documented. CONCLUSIONS: The design's unique elements of regular evaluation of healthcare needs for targeted individuals within the long-term care insurance context will allow new understanding of the role and effectiveness of preventive home visits.