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

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.