School of Nursing, Osaka City University, 1-5-17 Asahi Abeno, Osaka 545-0051, Japan.
J Gerontol A Biol Sci Med Sci. 2012 Mar;67(3):302-9. doi: 10.1093/gerona/glr176. Epub 2011 Oct 19.
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.
本研究旨在探讨针对行动不便的日本衰弱老年人的家庭访视预防计划对功能和心理社会参数及长期护理利用的影响。
合格的参与者（n=323）被随机分配到干预组（n=161）或对照组（n=162）。护士和护理经理每 6 个月对干预组参与者进行一次结构化的家庭访视，为期 2 年。通过邮件问卷在基线和 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）、抑郁和社会支持的数据。在此期间记录了长期护理保险的使用情况。
双向方差分析显示总体上没有显著的结果差异。在基线时至少有一项 ADL 依赖的参与者的预先计划的亚组分析中，干预组（n=105）在 2 年内功能和抑郁恶化的可能性明显低于对照组（n=100）：ADL（p=.0311）、IADL（p=.0114）、抑郁（p=.0001）。干预组（36001 积分）在 2 年内的总长期护理费用高于对照组（26022 积分）（无显著性），并且在干预开始后 7 个月至 15 个月期间，干预组的老年人利用社区和机构长期护理服务的比例明显高于对照组。
结果表明，对于整体行动不便的衰弱老年人，预防家庭访视计划可能对功能和心理社会状态无效，尽管它可能显著改善 ADL、IADL 和依赖 ADL 的抑郁。
