Preventive home visit model targeted to specific care needs of ambulatory frail elders: preliminary report of a randomized trial design

Abstract

The aim of this article is to describe the program and study design of our preventive home visit model that targets the specific care needs of Japanese ambulatory frail elders living at home. The program focused on ambulatory frail elders who were certified as being in the two lowest levels of care need in the Long-Term Care Insurance system and eligible for care, but who were currently not using long-term care services. To provide efficient community- based preventive care, we developed a program model composed of structured assessments and individualized care recommendations conducted by community care nurses or workers. The assessment protocol focused on locomotion, activities of daily living, social activities, health status, and possibility of abuse. Care needs were clarified every six months over two years. The effectiveness of the program is being assessed in a randomized controlled trial. A total of 243 elders were assigned randomly to the preventive home-visit intervention (n=122) or control group (n=121). Their mean age was 80 years, 76% were women, and 25% lived alone. Outcomes including ADLs, IADLs, depression, and social support were measured by postal questionnaire at baseline, and at 12- and 24-month follow-ups. Utilization of public health or long-term care insurance and service uses over the period is also being documented. The design's unique elements of regular evaluation of healthcare needs for targeted individuals within the long-term care insurance context will allow new understanding of the role and effectiveness of preventive home visits.