Department of General Practice, EMGO Institute, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
J Gerontol A Biol Sci Med Sci. 2010 Jul;65(7):734-42. doi: 10.1093/gerona/glq037. Epub 2010 May 9.
Can indicative prevention of home-visiting nurses be effective when targeted at a frail senior population using multidimensional geriatric assessments and personalized care plans?
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.
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.
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.
通过多维老年评估和个性化护理计划，针对体弱的老年人群进行有指示性的家访护士预防，是否有效？
我们在 18 个月内对 33 个盲法初级保健实践进行了个体随机对照试验。651 名参与者年龄在 75 岁或以上，居住在家庭中，身体虚弱但既没有绝症也没有痴呆。至少有两个自我报告的功能健康领域（COOP-WONCA 图表）的评分处于最低四分位数，定义为健康脆弱。我们将常规护理与经过培训的社区护士的主动家访进行了比较。护士（a）使用多维计算机化老年仪器评估护理需求，这可以直接识别健康风险；（b）与患者共同确定护理重点；（c）设计并执行个性化的干预措施；（d）通过电话和平均三次家访监测参与者。主要结局指标是功能健康和日常活动的工具性残疾。次要结局是急性住院入院（时间）、住院和死亡。
我们在任何结局指标上都没有发现干预组和常规护理组之间的显著差异。预先定义的亚组分析显示，干预组健康状况较差的患者住院的风险更高。
我们不能证明护士家访对脆弱老年人有预防作用。在最脆弱的群体中，住院人数增加。需要进一步调查寻找针对脆弱人群的有效干预措施。未来的努力可能侧重于改进综合方法。
