Effects of a Preventive Home Visit Program in Ambulatory Frail Older People: A Randomized Controlled Trial

Kono, Ayumi; Kanaya, Yukiko; Fujita, Tomoko; Tsumura, Chieko; Kondo, Tomoko; Kushiyama, Kyoko; Rubenstein, Laurence Z.

doi:10.1093/gerona/glr176

Cited by 51 publications

(67 citation statements)

References 21 publications

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“…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%

“…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%

“…The effects of changing health behaviours to prevent frailty are mixed, 12,48 which could arise from ineffectiveness in achieving behaviour change or the ineffectiveness of the behaviour change upon the outcome. Health behaviours can be defined as activities that may contribute to disease prevention, disease or disability detection, health promotion or protection from risk of injury.…”

Section: Key Findingsmentioning

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%

“…Previous interventions have focused on preventing decline or reducing frailty in the highest-risk populations with moderate-severe frailty, with limited success. [11][12][13] Although moderate-severe frailty has a higher risk of decline than mild frailty, older people with mild frailty are also more likely to transition back to a robust state or remain stable than those BOX 1 Commonly used definitions of mild frailty [7][8][9][10] Fried frailty phenotype Pre-frailty' defined as one or two characteristics from the following: slow gait speed, weight loss, low physical activity, low energy and weakness. 10 …”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Key Findingsmentioning

confidence: 99%

Section: Behavioural Targetsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

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Comprehensive Geriatric Assessment for community-dwelling, high-risk, frail, older people

Briggs

McDonough

Ellis

et al. 2022

Cochrane Database of Systematic Reviews

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Case management for integrated care of older people with frailty in community settings

Sadler

Khadjesari

Ziemann

et al. 2023

Cochrane Database of Systematic Reviews

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Background Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co‐ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well‐being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co‐ordinated care due to fragmented care systems. Objectives To assess the effects of case management for integrated care of older people living with frailty compared with usual care. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, Health Systems Evidence, and PDQ Evidence and databases from inception to 23 September 2022. We also searched clinical registries and relevant grey literature databases, checked references of included trials and relevant systematic reviews, conducted citation searching of included trials, and contacted topic experts. Selection criteria We included randomised controlled trials (RCTs) that compared case management with standard care in community‐dwelling people aged 65 years and older living with frailty. Data collection and analysis We followed standard methodological procedures recommended by Cochrane and the Effective Practice and Organisation of Care Group. We used the GRADE approach to assess the certainty of the evidence. Main results We included 20 trials (11,860 participants), all of which took place in high‐income countries. Case management interventions in the included trials varied in terms of organisation, delivery, setting, and care providers involved. Most trials included a variety of healthcare and social care professionals, including nurse practitioners, allied healthcare professionals, social workers, geriatricians, physicians, psychologists, and clinical pharmacists. In nine trials, the case management intervention was delivered by nurses only. Follow‐up ranged from three to 36 months. We judged most trials at unclear risk of selection and performance bias; this consideration, together with indirectness, justified downgrading the certainty of the evidence to low or moderate. Case managem...

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Effects of a Preventive Home Visit Program in Ambulatory Frail Older People: A Randomized Controlled Trial

Abstract: 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.

Cited by 51 publications

References 21 publications

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

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

Comprehensive Geriatric Assessment for community-dwelling, high-risk, frail, older people

Case management for integrated care of older people with frailty in community settings

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