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Effects of an Advanced Practice Nurse In‐Home Health Consultation Program for Community‐Dwelling Persons Aged 80 and Older
Author(s) -
Imhof Lorenz,
Naef Rahel,
Wallhagen Margaret I.,
Schwarz Jürg,
MahrerImhof Romy
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12026
Subject(s) - medicine , intervention (counseling) , quality of life (healthcare) , randomized controlled trial , incidence (geometry) , gerontology , physical therapy , health promotion , family medicine , health care , nursing , public health , physics , optics , economics , economic growth
Objectives To evaluate the effects of an advanced practice nurse ( APN ) in‐home health consultation program ( HCP ) on quality of life, health indicators (falls, acute events), and healthcare utilization. Design Randomized clinical trial. Setting One urban area in the G erman‐speaking part of Switzerland. Participants Four hundred sixty‐one community‐dwelling individuals aged 80 and older (mean age 85, 72.7% female, all Caucasian) participated in the intervention (n = 231) and control (n = 230) groups. Intervention After a comprehensive geriatric assessment, participants were randomly assigned to the 9‐month HCP with four in‐home visits and three phone calls from APN s or to a control group with standard care with no intervention. Measurements The primary outcome was quality of life at 3, 6, and 9 months. Secondary outcomes were incidence of falls, acute events due to health problems, and healthcare utilization measured for 3‐month periods at 3, 6, and 9 months. Results The intervention and control groups did not differ significantly on any dimension of the W orld H ealth O rganization Quality of Life questionnaire but differed significantly over 9 months in self‐reported acute events (116 vs 168, relative risk ( RR ) = 0.70, P = .001), falls (74 vs 101, RR = 0.71, P = .003), consequences of falls (63.1% vs 78.7%, chi‐square = 7.39, P = .007), and hospitalizations (47 vs 68, RR = .70, P = .03). Conclusion The in‐home HCP provided by APN s and guided by the principles of health promotion, empowerment, partnership, and family‐centeredness, can be effective in reducing adverse health outcomes such as falls, acute events, and hospitalizations.