Growing old at home – A randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826]

Abstract

BackgroundRegarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial.MethodsThe trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session.The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160).Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective.DiscussionTo the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.

Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial

“…Recently, reports of the effectiveness of nurse home visits to elderly people have been published42,43 without conclusive results. Stuck et al43 presented a systematic review and a meta-analysis that included 18 trials with a total of 13,447 individuals older than 75 years with the aim of evaluating the effect of home visits on functional status, admission to nursing homes, and mortality.…”

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

“…Information provided about the exact content of the instrument varied between CGAs. For five CGA instruments, the content of the CGA was available in (the appendix of) the original study or in a study cited in the original study (Buurman et al, ; Buurman, Parlevliet, van Deelen, de Haan, & de Rooij, ; Fleischer et al, ; Ruikes et al, , ; Stijnen, Duimel‐Peeters, et al, ; Suijker et al, , ). For the other CGAs, the original study did not provide or only partially provided the exact content of the CGA nor referred to other papers describing this information.…”

“…Examples of domains that were less frequently covered were abuse signs (e.g. physical or emotional abuse; Kono et al, ; Van Hout et al, ), finances (Fleischer et al, ; Suijker et al, , ), and providing informal care (Stijnen, Duimel‐Peeters, et al, ). In addition to addressing different life domains, some CGAs included a section in which concerns, priorities and goals of the older person and the informal carer were explicitly assessed.…”

Filipino Elderly's Sense of Reminiscence, Living Disposition, and End-of-Life Views

“…According to Fleischer et al (2008), most people prefer to age at home in a familiar environment rather than move to a nursing institution. Despite good care received, nursing home residents tend to feel like inmates (Nystrom, 1994, cited in Ronnberg, 1998 and function as isolated individuals (Ronnberg, 1998).…”

“…There are instances when support other than the spouse's or children's may be utilized. While it is true that traditional forms of support for the elderly are replaced by new formal and informal support systems (Fleischer et al, 2008), which include relatives, friends, and confidants (Giles,Glonek,Luszcz,& Andrews,612 A. …”