Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial

Jesús Favela,¹ Luis A Castro,² Francisco Franco-Marina,³ Sergio Sánchez-García,⁴ Teresa Juárez-Cedillo,⁴ Claudia Espinel Bermudez,⁴ Julia Mora-Altamirano,⁴ Marcela D Rodriguez,⁵ Carmen García-Peña<sup>4

1</sup>Center for Scientific Research and Higher Education of Ensenada, Ensenada, Baja California, Mexico; ²Sonora Institute of Technology, Ciudad Obregon, Mexico; ³National Institute of Respiratory Diseases, Mexican Ministry of Health, Mexico City, Mexico; ⁴Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico; ⁵School of Engineering, MyDCI, Autonomous University of Baja California, Mexicali, Mexico

Objective: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults.
Design: Unblinded, randomized, controlled trial.
Setting: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.
Participants: Patients were aged over 60 years with a frailty index score higher than 0.14.
Intervention: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.
Measurements: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.
Results: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group.
Conclusion: An intervention based on NV+AB seems to have a positive effect on frailty scores.

Keywords: gerontechnology, frailty, elderly