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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.