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

Abstract

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.

Multi-component health promotion and disease prevention for community-dwelling frail elderly persons: a systematic review

“…The mean age of all participants was 79 years, and 69% of the participants were women (supplementary materials/appendix 1). The methodological quality of included trials varied; seven trials (Hall et al 1992;Leveille et al 1998;Mann et al 1999;Dalby et al 2000;Rockwood et al 2000;Chin et al 2001;Phelan et al 2004;Holland et al 2005) were of low quality according to the criteria (van Tulder et al 2003), and seven trials were of high quality (Dalby et al 2000;Stuck et al 2000;van Haastregt et al 2000;Hebert et al 2001;Gill et al 2002Gill et al , 2004Gitlin et al 2006a;b;Markle-Reid et al 2006) ( Table 1).…”

“…Finally, a total of 19 articles (Hall et al 1992;Leveille et al 1998;Mann et al 1999;Dalby et al 2000;Rockwood et al 2000;Stuck et al 2000;van Haastregt et al 2000;Chin et al 2001;Hebert et al 2001;Chin et al 2002;Gill et al 2002Gill et al , 2004Phelan et al 2004;Holland et al 2005;Gitlin et al 2006a;b;Markle-Reid et al 2006;Bouman et al 2008a, b), all RCTs concerning communitydwelling persons 65 years or older identified as frail, vulnerable, at risk of functional decline, having disabilities or chronic conditions and receiving multi-component HPDP interventions were included for detailed review (Fig. 1).…”

“…As a consequence, a person can be frail but not necessarily disabled since activity limitations and participation restrictions are seen as a possible outcome of frailty not as a part of the concept itself. Subsequently, the concept of frailty was operationalised as the elderly person being inactive in combination with involuntary weight loss or low body mass index (BMI) (Chin et al 2001(Chin et al , 2002, alternatively having at least one (Leveille et al 1998;Chin et al 2001Chin et al , 2002Phelan et al 2004;Holland et al 2005) or three chronic conditions (Stuck et al 2000). Others considered an older person to be frail based on the existence of multiple medical problems (Rockwood et al 2000) or unspecified functional impairments (Dalby et al 2000;Rockwood et al 2000).…”

“…The issue of external, environmental, influences on functioning broadens the definition of frailty even further (Dalby et al 2000;Rockwood et al 2000;Stuck et al 2000;Markle-Reid et al 2006). For instance, persons reporting admission to hospital in the previous 6 months (Dalby et al 2000), or who reported frequent physician contacts (Rockwood et al 2000), were regarded as frail.…”

“…For instance, persons reporting admission to hospital in the previous 6 months (Dalby et al 2000), or who reported frequent physician contacts (Rockwood et al 2000), were regarded as frail. In another study, an elderly person's use of six or more medications, one of several elements included in the term at risk of functional decline, was considered to be accumulating factors leading to a high risk of future nursing home admission (Stuck et al 2000). Polypharmacy and adverse drug events were added as inclusion criteria in another trial (Rockwood et al 2000).…”