A Randomized Trial of In-Home Visits for Disability Prevention in Community-Dwelling Older People at Low and High Risk for Nursing Home Admission

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Abstract
THE INCREASING health and social care services required by disabled older persons will be a growing burden and a major societal concern.1,2 One possible means of coping with this development would be to devise and implement strategies for detecting and modifying biological, psychological, social, and environmental risk factors for disabilities in order to prevent or delay their onset.3 Several investigators have developed and tested preventive home visitation programs in community-dwelling older people as a strategy for delaying the development of disabilities and reducing nursing home admissions in older people.4-12 Although some studies have shown favorable effects on health status and health care use in older people,4,6,8-10,12 others have not.5,7,11 Some of the discrepancies in these findings might be explained by differences in the design of the preventive interventions, such as the duration and intensity of the home visits.13 However, other factors might also explain the variable study findings. First, it is uncertain whether all or only subgroups of the older population benefit from preventive home visits. Exploratory subgroup analyses of one trial suggested that subjects with good baseline functional status benefit from preventive home visits.14 Second, we identified variations in the intervention approach between the nurses conducting the home visits in an earlier study.4 Although such variations in the intervention process might influence outcomes in any type of preventive home visitation or comprehensive geriatric assessment program, none of the previous studies addressed this issue.4-18