Paper
Wednesday, July 11, 2007
This presentation is part of : Aging Healthcare
A Randomized Controlled Trial of a Preventive Primary Care Outreach Nursing Intervention Targeting High Risk Older Adults
Jenny Ploeg, PhD1, Kevin Brazil, PhD, MA, BA2, Brian Hutchison, MD, MSc, FCFP3, Janusz Kaczorowski, PhD4, Dawn M. Dalby, PhD5, Charles H. Goldsmith, PhD6, and William Furlong, MSc2. (1) School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, (2) Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, (3) Departments of Family Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada, (4) Department of Family Medicine, McMaster University, Hamilton, ON, Canada, (5) Department of Kinesiology and Physical Education, Wilfred Laurier University, Waterloo, ON, Canada, (6) Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
Learning Objective #1: Describe the preventive primary care nursing interventions used in this randomized controlled trial targeting high risk older adults.
Learning Objective #2: Discuss the impact of the intervention on quality of life, functional status, mortality, self-rated health, and costs.
The aging of society, rising health care costs, and the shortage of health care resources have created challenges in the provision of high quality, comprehensive care for older adults.  The literature has suggested that a preventive approach based on identifying individuals at risk and providing early intervention can prevent functional decline, promote independence and reduce health costs.  Similar interventions have been evaluated elsewhere but have not rigorously examined the impact on quality of life and use and costs of health and social services.   

 

The goal of the Preventive Primary Care Outreach controlled trial was to evaluate the effectiveness of a nursing intervention provided to high risk community-dwelling adults aged 75 years and older on: (a) health-related quality of life, (b) use of health and social services and associated costs, (c) functional status, (d) mortality, and (e) self-rated health. 

 

719 older adults (mean age 81 years) were randomly allocated to the intervention (n=361) and the control (n=358) group.  Participants were screened using the Sherbrooke Postal Questionnaire (score of 2 or more) and recruited through their family physicians.    

 

Seniors in the intervention group were visited by nurse case managers who conducted a comprehensive assessment using the Resident Assessment Instrument (RAI) for Home Care at baseline, 6 months and 12 months.  Nurses worked with participants, families, informal care providers and family physicians to plan and implement a range of preventive interventions. 

 

There were no statistically significant differences between intervention and control groups on: (a) health-related quality of life scores (HUI3) and Quality Adjusted Life Years, (b) functional status, (c) mortality (10 persons died per group), and self-rated health.   Results related to use and costs of health and social services will be discussed. 

 

In conclusion, there is insufficient evidence to justify widespread adoption of this intervention with this population of older adults. 

 

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