Prevention of adverse health trajectories in a vulnerable elderly population through nurse home visits: a randomized controlled trial [ISRCTN05358495]

Abstract

Objective: Can indicative prevention of home-visiting nurses be effective when targeted at a frail senior population using multidimensional geriatric assessments and personalized care plans?

Methods: We performed an individually randomized controlled trial in 33 blinded primary care practices over 18 months. The 651 participants were aged 75 years or older, lived at home, and were frail but neither terminally ill nor demented. A score in the lowest quartile on at least two of six self-reported functional health domains (COOP-WONCA charts), defined frail health. We compared usual care with proactive home visits by trained community nurses. The nurses (a) assessed the care needs with a multidimensional computerized geriatric instrument, which enabled direct identification of health risks; (b) determined care priorities together with the person; (c) designed and executed individually tailored interventions; and (d) monitored participants by telephone and on average three home visits. Primary outcome measures were functional health and instrumental activities of daily living disability. Secondary outcomes were acute hospital admittance (time until), institutionalization, and mortality.

Results: We found no significant differences between intervention and usual care group on any of the outcome measures. Predefined subgroup analyses revealed a higher risk of hospital admission for persons with poor health in the intervention group.

Conclusions: We could not demonstrate preventive effects of home visits by nurses in vulnerable older persons. Hospital admissions increased in the frailest group. The search for effective interventions for vulnerable persons requires further investigation. Future efforts may focus on improved integrated approaches.