A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission

Background: In-home preventive visits with multidimensional geriatric asses sments can delay the onset of disabilities in older people. Methods: This was a stratified randomized trial. There were 791 participant s, community-dwelling people in Bern, Switzerland, older than 75 years. The participants' risk status was based on 6 baseline predictors of functional deterioration. The intervention consisted of annual multidimensional asses sments and quarterly follow-up in-home visits by 3 public health nurses (nu rses A, B, and C), who, in collaboration with geriatricians, evaluated prob lems, gave recommendations, facilitated adherence with recommendations, and provided health education. Each nurse was responsible for conducting the h ome visits in 1 ZIP code area. Results: After 3 years, surviving participants at low baseline risk in the intervention group were less dependent in instrumental activities of daily living (ADL) compared with controls (odds ratio, 0.6; 95% confidence interv al, 0.3-1.0; P = .04). Among subjects at high base-line risk, there were no favorable intervention effects on ADL and an unfavorable increase in nursi ng home admissions (P = .02). Despite the similar health status of subjects , nurse C identified fewer problems in the subjects who were visited compar ed with those assessed by nurses A and B. Subgroup analysis revealed that a mong low-risk subjects visited by nurses A and B, the intervention had favo rable effects on instrumental ADL (P = .005) and basic ADL (P = .009), redu ced nursing home admissions (P = .004), and resulted in net cost savings in the third year (US $1403 per person per year). Among low-risk subjects vis ited by nurse C, the intervention had no favorable effects. Conclusions: These data suggest that this intervention can reduce disabilit ies among elderly people at low risk but not among those at high risk for f unctional impairment, and that these effects are likely related to the home visitor's performance in conducting the visits.