title: Effects of an Updated Preventive Home Visit Program Based on a Systematic Structured Assessment of Care Needs for Ambulatory Frail Older Adults in Japan: A Randomized Controlled Trial.
abstract: The aim of this randomized controlled trial was to determine the effects on functional parameters of an updated preventive home visit program for frail older adults in the Japanese Long-term Care Insurance (LTCI) system.
  
  
  
  The program included home visits by nurses or care managers every 3 months for 24 months, with a systematic assessment of care needs to prevent functional decline. Eligible participants (N = 360) were randomly assigned to the visit (VG: n = 179) or control group (CG: n = 181). Functional parameters were gathered via mail questionnaires at baseline and at 12- and 24-month follow-ups. Care-need levels in the LTCI were obtained at 12-, 24-, and 36-month follow-ups and the utilization of the LTCI service through 36 months.
  
  
  
  Participants in VG were significantly more likely to maintain their activities of daily living (ADL) functioning (p = .0113) and less likely to increase care-needs level, compared with CG participants, over 24 months. A generalized linear model showed that the estimate of the effect on increase in care-needs level (ie, functional decline) was -0.53 (p = .042) over 36 months.
  
  
  
  These results suggest that the updated preventive home visit program could be effective for the prevention of ADL and care-needs deterioration, and these effects could continue up to 1 year after program completion.
authors.affiliation: Department of Home Health Nursing, Faculty of Nursing, Osaka City University, Japan. ayukono-tky@umin.ac.jp.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Kono
authors.affiliation: Department of Public Health Nursing, School of Nursing, Mukogawa Women's University, Nishinomiya, Hyogo, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Izumi
authors.affiliation: Department of Home Health Nursing, Faculty of Nursing, Osaka City University, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshiyuki
authors.affiliation: Department of Home Health Nursing, Faculty of Nursing, Osaka City University, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kanaya
authors.affiliation: Department of Geriatric Medicine, College of Medicine, University of Oklahoma.
authors.forename: Laurence Z
authors.initials: LZ
authors.lastname: Rubenstein
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D008297:Male; D011314:Preventive Health Services / Q000458:organization & administration*; D016037:Single-Blind Method; D011795:Surveys and Questionnaires
keywords: Frailty; Geriatric assessment; Long-term care; Preventive home visit; Randomized controlled trial