Effects of a Home Visiting Program for Older People with Poor Health Status: A Randomized, Clinical Trial in the Netherlands

Bouman, A.; Rossum, Erik van; Ambergen, Ton; Kempen, Gertrudis I. J. M.; Knipschild, Paul

doi:10.1111/j.1532-5415.2007.01565.x

Cited by 62 publications

(90 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Compared to other recent studies in the Netherlands in which the effect of the preventive home visits was absent (Bouman et al 2008;Van Hout et al 2010), the [G]OLD home visitation programme is fully embedded within general practices. It comprises elements of the Guided Care model that has shown to be feasible and acceptable for patients and caregivers (Boyd et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices

Stijnen

Jansen²,

Vrijhoef

et al. 2012

Eur J Ageing

View full text Add to dashboard Cite

The integration within existing health care systems of preventive initiatives to maintain independent living among older people is increasingly emphasized. This article describes the development and refinement of the [G]OLD home visitation programme: an eight-step programme, including a comprehensive geriatric assessment, for the early detection of health and well-being problems among older people (C75 years) by general practices. A single group post-test study using a mixed model design is performed to evaluate (a) the feasibility of the home visitation programme in general practice, (b) the practical usefulness of the geriatric assessment instrument, and (c) programme implementation with respect to reinventions introduced by general practitioners (GPs) and practice nurses (PNs). Within 3 months time, 22 PNs of 18 participating general practices visited 240 community-dwelling older people (mean age = 82.0 years; SD 4.2) who had not been in contact with their general practice for more than 6 months. Mean time investment of the programme per older person was 118.1 min (SD 27.0) for GPs and PNs combined. Evaluation meetings revealed that GPs and PNs considered the home visitation programme to be feasible in daily practice. They judged the geriatric assessment to be useful, although minor adjustments are needed (e.g., layout, substitution of tests). PNs often failed to register follow-up actions for detected problems in a care and treatment plan. Future training for PNs should address this issue. No reinventions were introduced that threatened fidelity of implementation. The findings are used to improve the home visitation programme before its evaluation in a large-scale controlled trial.

show abstract

Section: Discussionmentioning

confidence: 99%

Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices

Stijnen

Jansen²,

Vrijhoef

et al. 2012

Eur J Ageing

View full text Add to dashboard Cite

show abstract

“…Physical health and functioning outcomes were most commonly assessed (n = 19), followed by mental health and functioning, health and social service use and generic health and well-being (n = 11). Social functioning and well-being was assessed in seven 12,57,[64][65][66]70,71 studies and behavioural outcomes in four.…”

Section: Resultsmentioning

confidence: 99%

“…We included 19 studies of people who were frail or at risk of frailty: 16 RCTs, 12,13,[56][57][58][59][60][61][62][63][64][65][66][67][68][69] two clusters RCTs 48,70 and one pseudocluster RCT 71 (see Report Supplementary Material 3 for study characteristics). Most (n = 16) compared one intervention to control, with three three-arm trials.…”

Section: Resultsmentioning

confidence: 99%

“…48,63,64 Most interventions (n = 11/22) targeted a single behaviour, 12,[61][62][63][64][66][67][68]70,71 while nine targeted two or three behaviours 13,[56][57][58][59]65,69 and two targeted four or more behaviours. 48, 60 The behaviours most commonly targeted were medication adherence or management (n = 16), 13,48,56,[58][59][60][61][63][64][65][66]68,69 physical activity (n = 11) 12,13,48,56,57,59,60,65,70 and diet (n = 8), 13,48,56,57,60,69...…”

Section: Behavioural Targetsmentioning

confidence: 99%

See 1 more Smart Citation

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

Background Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. Objectives (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Design Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Intervention development Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Feasibility RCT Single-blind RCT, individually randomised to ‘HomeHealth’ or treatment as usual (TAU). Setting Community settings in London and Hertfordshire, UK. Participants A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Main outcome measures Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. Results We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Conclusions Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. Future work A large, definitive RCT of the HomeHealth service is warranted. Study registration This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.

show abstract

“…There is a lack of studies focusing on those with poor mental health. There was, however, one study by Bouman et al (2008) that had mental health as one inclusion criterion. This study included those with a poor self-rated health, where self-rated health represented an overall measure of functional health abilities, including physical, mental and social functioning.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of healthcare utilization among older people (60+): Focusing on ADL dependency and risk of depression

Sandberg

Kristensson

Midlöv

et al. 2012

Archives of Gerontology and Geriatrics

View full text Add to dashboard Cite

Effects of a Home Visiting Program for Older People with Poor Health Status: A Randomized, Clinical Trial in the Netherlands

Abstract: The home visiting program did not appear to have any effect on the health status of older people with poor health and are probably not beneficial for such persons.

Cited by 62 publications

References 29 publications

Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices

Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Prevalence and predictors of healthcare utilization among older people (60+): Focusing on ADL dependency and risk of depression

Contact Info

Product

Resources

About