Effects of a Preventive Home Visit Program in Ambulatory Frail Older People: A Randomized Controlled Trial
Effects of a Preventive Home Visit Program in Ambulatory Frail Older People: A Randomized Controlled Trial
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DOI：
10.1093/gerona/glr176
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发表时间：
2012-03-01
影响因子：
5.1
通讯作者：
Rubenstein, Laurence Z.
中科院分区：
文献类型：
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作者：
Kono, Ayumi;Kanaya, Yukiko;Rubenstein, Laurence Z.
本研究的目的是检查预防性家访计划对流动性虚弱的日本老年人的功能和心理社会参数以及长期护理利用的影响。符合条件的参与者 (n = 323) 被随机分配到干预组 (n = 161) 或对照组 (n = 162)。护士和护理经理在 2 年内每 6 个月对干预组参与者进行一次结构化的预防性家访。通过邮寄问卷在基线以及 12 个月和 24 个月的随访点收集日常生活活动 (ADL)、工具性日常生活活动 (IADL)、抑郁和社会支持。记录了该期间长期护理保险的使用情况。协方差的双向分析总体上没有显示显着的结果差异。在对基线时至少有一种 ADL 依赖的参与者进行的预先计划的亚组分析中，干预组 (N = 105) 的参与者在 2 年内其功能和抑郁症恶化的可能性明显低于对照组 (N = 100)：ADL (p = .0311)、IADL (p = .0114)、抑郁症 (p = .0001)。干预组2年以上的长期护理总费用（36,001学分）高于对照组（26,022学分）（不显着），并且在干预开始后7个月至15个月期间，干预组的老年人比对照组使用更多的社区和机构长期护理服务。结果表明，预防性家访计划可能对流动体弱老年人的功能和心理社会状态无效。总体而言，尽管它可能会显着改善 ADL 依赖者的 ADL、IADL 和抑郁症。
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.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.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.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.