Stuck A E, Minder C E, Peter-Wüest I, Gillmann G, Egli C, Kesselring A, Leu R E, Beck J C
Department of Geriatrics and Rehabilitation, Zieglerspital, Bern, Switzerland.
Arch Intern Med. 2000 Apr 10;160(7):977-86. doi: 10.1001/archinte.160.7.977.
In-home preventive visits with multidimensional geriatric assessments can delay the onset of disabilities in older people.
This was a stratified randomized trial. There were 791 participants, community-dwelling people in Bern, Switzerland, older than 75 years. The participants' risk status was based on 6 baseline predictors of functional deterioration. The intervention consisted of annual multidimensional assessments and quarterly follow-up in-home visits by 3 public health nurses (nurses A, B, and C), who, in collaboration with geriatricians, evaluated problems, gave recommendations, facilitated adherence with recommendations, and provided health education. Each nurse was responsible for conducting the home visits in 1 ZIP code area.
After 3 years, surviving participants at low baseline risk in the intervention group were less dependent in instrumental activities of daily living (ADL) compared with controls (odds ratio, 0.6; 95% confidence interval, 0.3-1.0; P = .04). Among subjects at high baseline risk, there were no favorable intervention effects on ADL and an unfavorable increase in nursing home admissions (P= .02). Despite the similar health status of subjects, nurse C identified fewer problems in the subjects who were visited compared with those assessed by nurses A and B. Subgroup analysis revealed that among low-risk subjects visited by nurses A and B, the intervention had favorable effects on instrumental ADL (P = .005) and basic ADL (P = .009), reduced nursing home admissions (P = .004), and resulted in net cost savings in the third year (US $1403 per person per year). Among low-risk subjects visited by nurse C, the intervention had no favorable effects.
These data suggest that this intervention can reduce disabilities among elderly people at low risk but not among those at high risk for functional impairment, and that these effects are likely related to the home visitor's performance in conducting the visits.
进行多维老年评估的居家预防性访视可延缓老年人残疾的发生。
这是一项分层随机试验。共有791名参与者，为瑞士伯尔尼年龄超过75岁的社区居民。参与者的风险状况基于功能恶化的6项基线预测指标。干预措施包括每年进行多维评估以及由3名公共卫生护士（护士A、B和C）每季度进行一次随访居家访视，这些护士与老年病医生协作，评估问题、给出建议、促进对建议的依从性并提供健康教育。每位护士负责在1个邮政编码区域进行居家访视。
3年后，干预组中基线风险较低的存活参与者与对照组相比，在工具性日常生活活动（ADL）方面的依赖性较低（优势比为0.6；95%置信区间为0.3 - 1.0；P = 0.04）。在基线风险较高的受试者中，对ADL没有有利的干预效果，且养老院入住率出现不利增加（P = 0.02）。尽管受试者的健康状况相似，但与护士A和B评估的受试者相比，护士C在访视的受试者中发现的问题较少。亚组分析显示，在护士A和B访视的低风险受试者中，干预对工具性ADL（P = 0.005）和基本ADL（P = 0.009）有有利影响，减少了养老院入住率（P = 0.004），并在第三年实现了净成本节约（每人每年1403美元）。在护士C访视的低风险受试者中，干预没有产生有利影响。
这些数据表明，这种干预可以降低低风险老年人的残疾率，但对功能受损高风险的老年人无效，并且这些效果可能与家访者的访视表现有关。
