Feasibility and Effects of Preventive Home Visits

预防性家访的可行性和效果

• 批准号: 7305874
• 负责人: MALCOLM P CUTCHIN
• 金额: $ 17.21万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7305874
• 关键词: Accident and Emergency department; Activities of Daily Living; Acute; Address; Adherence; Adult; Age; Aging; Assisted Living Facilities; Communities; Cost Savings; County; Data; Data Collection; Dimensions; Discipline of Nursing; Effectiveness of Interventions; Elderly; Europe; Evaluation; Exhibits; Family; Feedback; Goals; Health; Health Care Costs; Health Surveys; Home Care Services; Home environment; Home visitation; Hospitalization; House Call; Institutionalization; Intervention; Intervention Studies; Life; Long-Term Care; Measures; Medical; Methods; Modeling; North Carolina; Nurses; Occupational Therapist; Occupational Therapy; Oranges; Outcome; Outcome Measure; Outcome Study; Participant; Personal Satisfaction; Policies; Population; Preventive; Preventive Intervention; Printing; Psyche structure; Quality of life; Randomized; Rate; Reaction; Recommendation; Rehabilitation therapy; Research; Risk; SF-12; Score; Services; Telephone; Time; Training; Visit; Work; World Health Organization; base; comparison group; cost; design; disability; experience; falls; functional decline; improved; instrument; prevent; psychosocial; satisfaction

DESCRIPTION (provided by applicant): Aging in place is now recognized as a goal of most older adults. While medically driven interventions such as home health care assist older adults to age in place, these occur not as true preventive measures but as reactions to losses in function or health. The search for preventive methods to mitigate decline and unwanted moves from home and community is important. One such method, Preventive Home Visits (PHVs), has been utilized in parts of Europe for approximately two decades. The PHV model is based on infrequent but regular visits to an older adult's home by a trained practitioner (typically an occupational therapist or nurse). The visit is designed to assess the older person's situation and provide information and advice to optimize function and well-being. Evidence about PHV efficacy is mixed but generally supportive, and there is a distinct need to create and examine a preventive non-medical intervention model in the USA. A successfully developed and implemented approach could enhance lives and save costs. We plan to implement an intervention informed by a framework based on a synthesis of the World Health Organization function and disability model and the Occupational Therapy Practice Framework. We aim to implement and evaluate this PHV intervention in Orange County, North Carolina to assess the feasibility and effects of preventive home visits with older adults. We will use an experimental, repeated measures design in which approximately 120 older (75+ years) community-dwelling adults who are at-risk for functional decline are randomly assigned to experimental and comparison groups. The experimental group will receive the PHV intervention six times across a 12 month period. The comparison group will receive a minimal intervention of two informational phone calls and printed materials about local services during the same period. An occupational therapist with the requisite training and experience in home-based evaluation and intervention will conduct the experimental intervention. We will independently administer a set of standardized scales to both groups immediately pre-intervention, and again at regular intervals after each intervention. These outcome measures will cover the primary dimensions on which we hypothesize PHVs will have a positive influence: functional ability, participation, life satisfaction, and general health. Other outcomes include hospitalization and institutionalization. Analyses will compare the differences in outcomes for the two groups as well as assess several dimensions of intervention feasibility. These data will be the basis for a subsequent, enhanced intervention and study. The relevance of the proposed research lies in the evaluation of a preventive intervention that could assist older adults who are at-risk for institutionalization to remain at home and thereby maintain or improve their quality of life. The intervention could be made widely available, and it could prevent greater costs associated with acute and long-term care of the rapidly growing older adult population.

描述（由申请人提供）：居家养老现在被认为是大多数老年人的目标。虽然家庭保健等医疗驱动的干预措施可以帮助老年人原地衰老，但这些措施并不是真正的预防措施，而是对功能或健康丧失的反应。寻找预防方法来减轻衰退和不必要的家庭和社区搬迁非常重要。其中一种方法，即预防性家访 (PHV)，已在欧洲部分地区使用了大约二十年。 PHV 模型基于训练有素的从业者（通常是职业治疗师或护士）不频繁但定期拜访老年人的家中。这次访问的目的是评估老年人的情况，并提供信息和建议，以优化老年人的功能和福祉。关于 PHV 功效的证据参差不齐，但总体上是支持性的，并且明显需要在美国创建和检查预防性非医疗干预模型。成功开发和实施的方法可以改善生活并节省成本。我们计划实施一项干预措施，该干预措施以综合世界卫生组织职能和残疾模型以及职业治疗实践框架为基础的框架为依据。我们的目标是在北卡罗来纳州奥兰治县实施和评估这项 PHV 干预措施，以评估对老年人进行预防性家访的可行性和效果。我们将采用实验性重复测量设计，将大约 120 名有功能衰退风险的社区居住老年人（75 岁以上）随机分配到实验组和对照组。实验组将在 12 个月内接受 6 次 PHV 干预。对照组将在同一时期收到两次信息电话和有关当地服务的印刷材料的最少干预。具有家庭评估和干预方面必要培训和经验的职业治疗师将进行实验干预。我们将在干预前立即独立地对两组进行一套标准化量表，并在每次干预后定期再次进行。这些结果指标将涵盖我们假设 PHV 会产生积极影响的主要维度：功能能力、参与度、生活满意度和总体健康状况。其他结果包括住院和住院治疗。分析将比较两组结果的差异，并评估干预可行性的几个方面。这些数据将成为后续强化干预和研究的基础。拟议研究的相关性在于评估预防性干预措施，该干预措施可以帮助有入院风险的老年人留在家中，从而维持或改善他们的生活质量。这种干预措施可以广泛推广，并且可以防止因快速增长的老年人口的紧急和长期护理而产生更大的费用。