Effects of an advanced practice nurse in-home health consultation program for community-dwelling persons aged 80 and older

Abstract

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 German-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 APNs 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 World Health Organization 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 APNs 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