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Effect of preventive home visits by a nurse on the outcomes of frail elderly people in the community: a randomized controlled trial

Dawn M. Dalby^*, John W. Sellors^*, Fred D. Fraser, Catherine Fraser, Cornelia van Ineveld and Michelle Howard^*

From *the Health Services Delivery Research Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Hospital, Hamilton, Ont.; the Departments of Family Medicine and of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.; the Stoney Creek Clinic Health Service Organization, Stoney Creek, Ont.; and the Department of Geriatric Medicine, St. Boniface General Hospital, Winnipeg, Man.

Background: Timely recognition and prevention of health problems among elderly people have been shown to improve their health. In this randomized controlled trial the authors examined the impact of preventive home visits by a nurse compared with usual care on the outcomes of frail elderly people living in the community.

Methods: A screening questionnaire identified eligible participants (those aged 70 years or more at risk of sudden deterioration in health). Those randomly assigned to the visiting nurse group were assessed and followed up in their homes for 14 months. The primary outcome measure was the combined rate of deaths and admissions to an institution, and the secondary outcome measure the rate of health services utilization, during the 14 months; these rates were determined through a medical chart audit by a research nurse who was blind to group allocation.

Results: The questionnaire was mailed to 415 elderly people, of whom 369 (88.9%) responded. Of these, 198 (53.7%) were eligible, and 142 consented to participate and were randomly assigned to either the visiting nurse group (73) or the usual care group (69). The combined rate of deaths and admissions to an institution was 10.0% in the visiting nurse group and 5.8% in the usual care group (p = 0.52). The rate of health services utilization did not differ significantly between the 2 groups. Influenza and pneumonia vaccination rates were significantly higher in the visiting nurse group (90.1% and 81.9%) than in the usual care group (53.0% and 0%) (p < 0.001).

Interpretation: The trial failed to show any effect of a visiting nurse other than vastly improved vaccination coverage.

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