Laurence Z. Rubenstein

Objectives: To determine whether an enhanced occupational therapy discharge planning intervention that involved pre‐ and postdischarge home visits, goal setting, and follow‐up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in‐hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Design: Randomized controlled trial. Setting: Acute and medical wards. Participants: Individuals aged 70 and older (N = 400). Measurements: Primary outcomes: activities daily living ( ADL s; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index ( LLDI )). Results: Occupational therapist recommendations differed significantly between groups ( P < .001) ( HOME n = 892 recommendations; control n = 329 recommendations). There was no difference between groups in ADL s (Nottingham Extended Activities of Daily Living scale ( NEADL ): β = −0.17, 95% confidence interval ( CI ) = −0.99–0.66) or participation ( LLDI —Frequency: β = −0.23, 95% CI = −2.05–1.59; LLDI —Limitation: β = −0.14, 95% CI = −2.86–2.58). Both groups maintained prehospital functional status at 90 days, and there was no difference between groups in the number of people with unplanned readmissions ( HOME 23.5%, n = 43; control 21.9%, n = 37). When groups were combined, being male ( P = .03) or having lower perceived participation because of physical problems ( P = .04) resulted in higher risk of unplanned readmissions. Conclusion: HOME discharge planning, which had a strong emphasis on task modification, well‐being, and prevention strategies, implemented twice as many occupational therapy recommendations as the in‐hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADL s or participation in life tasks than in‐hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in‐hospital consultation.

Purpose: To determine the associative value of selected questions from the National Health Interview Survey (NHIS) for screening adults older than 18 years at risk of injurious falls. Methods: Data from adults 18 years of age and older were extracted from the NHIS for 2011 relevant to an injurious fall within the preceding year. A multivariate logistic regression model was used to determine associations of self-reported injurious falls with key social-demographic, health, and physical function variables. Outcomes were reported as odds ratio (OR) with 95% confidence intervals (CIs). Results: Self-reported injurious fall within the preceding year was associated with difficulty climbing 10 steps without special equipment (OR, 3.22; 95% CI, 2.32–4.46), loss of dependence for an activity of daily living (OR, 1.85; 95% CI, 1.17–2.91), pain in legs and below the knees (OR, 1.68; 95% CI, 1.23–2.30), and moderate visual impairment (OR, 1.59; 95% CI, 1.18–2.15). Women were at greater risk than men and those aged 75 years and older (OR, 1.46; 95% CI, 1.02–2.09). Conclusions: A subset of the NHIS questions are positively associated with injurious falls in the previous 12 months and may be of use in identifying adults at greater risk of future falls. The NHIS questions may serve to identify persons in need of targeted preventive services.

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.

Aim: To describe the programme and research protocol of our updated preventive home visit programme for ambulatory frail older adults in the Japanese Long‐Term Care Insurance system.Background: Our previous trials have shown that the nature of recommendations during preventive home visits is a key issue. The present programme has updated our previous one by including a unique structured assessment with treatment recommendations tied to an ongoing programme for quality assurance.Design: A randomized, controlled trial.Methods: Eligible participants (n = 360) will be randomly assigned to home visit (n = 179) and control (n = 181) groups in three suburban municipalities. Nurses provide recommendations based on structured assessments to participants in visit group every 3 months from September 2011–October 2013. The primary outcomes are parameters related to quality of life, including activities of daily living, instrumental activities of daily living, depression, cognitive capacity, daily‐life satisfaction and self‐efficacy for health promotion; these are collected by mail at baseline, 12 and 24 months. The secondary outcome is long‐term care use over the study period. To evaluate the visit process, we are qualitatively analysing documentation data from the assessment sheet and chart.Conclusion: This study is collecting and analysing evidence regarding the process and outcomes of preventive home visits based on structured care‐need assessments.Trial registration: The study protocol was registered for the UMIN clinical registry approved by ICMJE (No. UMIN000006463, October 04, 2011).

Background and aims Reducing health care costs through preventive geriatric care has become a high priority in Japan. We analyzed data from a randomized controlled trial to examine the effects of a preventive home visit program on health care costs among ambulatory frail elders. Methods Structured preventive home visits by nurses or care managers were provided to the visit group every 6 months over 2 years. The enrolled participants (N = 323) were randomly assigned to either the visit group (N = 161) or the control group (N = 162). We analyzed the health care costs, including the costs for hospitalizations and outpatient clinic utilization for participants who had health care insurance from the local government (N = 307). The visit group included 154 individuals in the visit group and 153 people in the control group. Results Total health care costs over the study period were not significantly different between groups, but at most monthly time points costs and those for outpatient clinic utilization in the visit group were lower than those in the control group. Hospitalizations, which accounted for more than ¥500,000 JPY per month, were less likely to occur more often among participants in the visit group (N = 71) than in the control group (N = 113) (OR = 0.63; p = 0.002). Conclusions These results suggest that a preventive home visit program may reduce monthly health care costs, primarily by reducing hospitalization costs.

Decreased functional ability is common in older adults after hospitalisation. Lower levels of functional ability increase the risk of hospital readmission and nursing care facility admission. Discharge planning across the hospital and community interface is suggested to increase functional ability and decrease hospital length of stay and hospital readmission. However evidence is limited and the benefits of occupational therapists providing this service has not been investigated.