Despite there being a considerable number of meta-analyses and reviews synthesizing the nurse in-home visiting literature, there have been no reviews examining nurse in-home visiting for patients who are already disabled. This article presents a literature review and synthesis of 10 trials targeted on older adults with disability. The review is organized into structure and process components related to the outcome variable disability based on the classic Donabedian model. The review suggests that the components of in-home visiting associated with favorable disability outcomes include multiple home visits, geriatric training and experience, health provider collaboration, multidimensional assessment, and theory use. In contrast, lack of process measures, physician collaboration, training, and specific intervention components targeting disability are associated with ineffective interventions. This review helps provide insight into variables that influence disability outcomes as well as the development of best-practice models of in-home visiting to older adults with existing disability.
Applegate, W., Blass, J., & Williams, T. (1990). Instruments for the functional assessment of older patients. New England Journal of Medicine, 322, 1207-1214.
2.
Bernabei, R., Landi, F., Gambassi, G., Sgadari, A., Zuccala, G., Mor, V., et al. (1998). Randomized trial of impact of model of integrated care and case management for older people living in the community . British Medical Journal, 316(7141), 1348-1351.
3.
Bouman, A., Van Rossum, E., Nelemans, P., Kempen, G., & Knipschild, P. (2008). Effects of intensive home visiting programs for older people with poor health status: A systematic review . BMC Health Service Research, 8(74), 1-11.
4.
Corti, M., Salive, M., & Guralnik, J. (1996). Serum albumin and physical function as predictors of coronary heart disease mortality and incidence in older persons. Journal of Clinical Epidemiology, 49(5), 519-526.
5.
Donabedian, A. (1966). Evaluating the quality of medical care. Milbank Memorial Fund Quarterly, 44(1), 166-206.
6.
Donabedian, A. (1980). Explorations in quality assessment and monitoring. The definition of quality and approaches to its assessment (Vol. 1). Ann Arbor, MI: Health Administration Press.
7.
Eggert, G., Zimmer, J., Hall, J., & Friedman, B. (1991). Case management: A randomized controlled study comparing a neighborhood team and a centralized individual model. Health Services Research, 26(4), 471-507.
8.
Elkan, R., Kendrick, D., Dewey, M., Hewitt, M., Robinson, J., Blair, M., et al. (2001). Effectiveness of home based support for older people: Systematic review and meta-analysis. British Medical Journal, 323(7315), 719-725.
9.
Enguidanos, S., Gibbs, N., Simmons, W., Savoni, K., Jamison, P., Hackstaff, L., et al. (2003). Kaiser Permanente Community Partners Project: Improving geriatric care management practices. Journal of the American Geriatric Society, 51(5), 710-714.
10.
Evans, C., Drennan, V., & Roberts, J. (2005). Practice nurses and older people: A case management approach to care. Journal of Advanced Nursing, 51(4), 342-353.
11.
Ferguson, J., & Weinberger, M. (1998). Case management programs in primary care. Journal of General Internal Medicine, 13(2), 123-126.
12.
Ferrucci, L., Guralnik, J., Simonsick, E., Salive, M., Corti, C., & Langlois, J. (1996). Progressive versus catastrophic disability: A longitudinal view of the disablement process. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 51(3), M123-M130.
13.
Fletcher, A., Price, G., Ng, E., Stirling, S., Bulpitt, C., Breeze, E., et al. (2004). Population-based multidimensional assessment of older people in UK general practice: A cluster-randomised factorial trial . The Lancet, 364(9446), 1667-1677.
14.
Foley, W., & Schneider, D. (1980). A comparison of the level of care predictions of six long-term care patient assessment systems. American Journal of Public Health, 70(11), 1152-1161.
15.
Fox, P., Retchin, S., & Thornton, C. (1998). Frail elders in Medicare managed care: Site visit report on HMO Oregon. (Draft report submitted to the Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy). Princeton, NJ: Mathematica Policy Research, Inc.
16.
Frich, L. (2003). Integrative literature reviews and meta-analyses: Nursing interventions for patients with chronic conditions. Journal of Advanced Nursing, 44(2), 137-153.
17.
Fried, L., Bradley, E., Williams, C., & Tinetti, W. (2001). Functional disability and health care expenditures for older persons. Archives of Internal Medicine, 161(21), 2602-2607.
18.
Fried, L., & Bush, T. (1988). Morbidity as a focus of preventive health care in the elderly. Epidemiologic Reviews, 10(1), 48-64.
19.
Fries, J., Spitz, P., Kraines, G., & Holman, H. (1980). Measurement of patient outcome in arthritis. Arthritis and Rheumatism, 23(2), 137-145.
20.
Gagnon, A., Schein, C., McVey, L., & Bergman, H. (1999). Randomized controlled trial of nurse case management of frail older people. Journal of the American Geriatric Society , 47(9), 1118-1124.
21.
Gauthier, S., Gelinas, I., & Gauthier, L. (1997). Functional disability in Alzheimer's disease. International Psychogeriatrics, 9(Suppl. 1), 163-165.
22.
George, L., & Fillenbaum, G. (1985). OARS methodology: A decade of experience in geriatric assessment. Journal of the American Geriatric Society, 33(9), 607-615.
23.
Gill, T., Hardy, S., & Williams, S. (2002). Underestimation of disability in community-living older persons. Journal of the American Geriatrics Society , 50(9), 1492-1497.
24.
Gill, T., Robison, J., & Tinetti, M. (1997). Predictors of recovery in activities of daily living among disabled older persons living in the community. Journal of General Internal Medicine, 12(12), 757-762.
25.
Gruenberg, L., Kaganova, E., & Hornbrook, M. (1996). Improving the AAPCC with health-status measures from the MCBS. Health Care Financing Review, 17(3), 59-75.
26.
Guralnik, J., & Ferrucci, L. (2002). Underestimation of disability occurrence in epidemiological studies of older people: Is research on disability still alive? Journal of the American Geriatric Society, 50(9), 1599-1601.
27.
Guttman, R. (1999). Case management of the frail elderly in the community . Clinical Nurse Specialist, 13(4), 174-178.
28.
Hallberg, I., & Kristensson, J. (2004). Preventive home care of frail older people: A review of recent case management studies. Journal of Clinical Nursing, 13(Suppl. 2), 112-120.
29.
Hay, W., Van Inevald, C., Browne, G., Roberts, J., Bell, B., Mills, M., et al. (1998). Prospective care of the elderly patients in family practice is screening effective? Canadian Family Physician, 44, 2677-2687.
30.
Health Care Financing Administration. (2000 ). US Department of Health and Human Services. OASIS data sets: OASIS-B1 final version. Retrieved April 10, 2007, from http://www.hcfa.gov/medicaid/oasis/oasisdat.htm
31.
Health Evidence Network. (2004). What is the effectiveness of home visiting or home-based support for older people?Copenhagen: WHO Regional Office for Europe (Health Evidence Network report). Retrieved May 10, 2006, from:http://www.euro.who.int/Document/e83105.pdf
32.
Hollander, M., & Pallan, P. (1995). The British Columbia continuing care system: Service delivery and resource planning. Aging Clinical and Experimental Research, 7(2), 94-109.
33.
Hughes, S., Weaver, F., Giobbie-Hurder, A., Manheim, L., Henderson, W., Kubal, J., et al. (2000). Effectiveness of team-managed home-based primary care. A randomized multi-center trial. Journal of the American Medical Association, 284(22), 2877-2885.
34.
Iliffe, S., Gould, M., & Wallace, P. (1999). Assessment of older people in the community: Lessons from Britain's "75-and-over checks."Reviews in Clinical Gerontology , 9(4), 305-316.
35.
Katz, S., Ford, A., Moskovitz, R., Jackson, B., & Jaffe, W. (1963). Studies of illness in the aged: The index of the ADL. Journal of the American Medical Association, 185, 914-919.
36.
Lawton, M., & Brody, E. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179-186.
37.
Lawton, M., Moss, M., Fulcomer, M., & Kleban, M. (1982). A research and service oriented multilevel assessment instrument. Journal of Gerontology, 37(1), 91-99.
38.
Lee, J., Chang, B., Pearson, M., Kahn, K., & Rubenstein, M. (1999). Does what nurses do affect clinical outcomes for hospitalized patients? A review of the literature. Health Services Research, 34(5, Part 1), 1011-1032
39.
Long, S., & Pavalko, E. (2004). Comparing alternative measures of functional limitation . Medical Care, 42(1), 19-27.
40.
Mahoney, F., & Barthel, D. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 56-61.
41.
Manton, K. (1988). A longitudinal study of functional change and mortality in the United States. Journal of Gerontology: Social Sciences, 43(5), S153-S161.
42.
Marek, K., & Baker, C. (2006). Nurse home visit programs for the elderly. Annual Review of Nursing Research, 24, 157-178.
43.
Marek, K., Popejoy, L., Petroski, G., & Rantz, M. (2006). Nurse care coordination in community based long term care. Journal of Nursing Scholarship, 38(1), 80-86.
44.
Markle-Reid, M., Browne, G., Weir, R., Gafni, A., Roberts, J., & Henderson, S. (2006). The effectiveness and efficiency of home-based nursing health promotion for older people: A review of the literature. Medical Care Research and Review, 63(5), 531-569.
45.
Markle-Reid, M., Weir, R., Browne, G., Roberts, J., Gafni, A., Henderson, S. (2006). Health promotion for frail older home care clients . Journal of Advanced Nursing, 54(3), 381-395.
46.
Marshall, B., Long, M., Voss, J., Demma, K., & Sheri, K. (1999). Case management of the elderly in a health maintenance organization: The implications for program administration under managed care . Journal of Healthcare Management, 44(6), 477-493.
47.
McNaughton, D. (2000). A synthesis of qualitative home visiting research . Public Health Nursing, 17(6), 405-414.
48.
Mezey, M., & Fulmer, T. (1998). Quality care for the elderly. Nursing Outlook, 46(6), 291-292.
49.
Miller, E., & Weissert, W. (2000). Predicting elderly people's risk for nursing home placement, hospitalization, functional impairment, and mortality: A synthesis . Medical Care, 57(3), 259-297.
50.
Mowbray, C., Holter, M., Teague, G., & Bybee, D. (2003). Fidelity criteria: Development, measurement, and validation. American Journal of Evaluation, 24(3), 315-340.
51.
Murphy, E. (2004). Case management and community matrons for long term conditions. British Medical Journal, 329(7477), 1251-1252.
52.
Newcomer, R., Manton, K., Harrington, C., Yordi, C., & Vertrees, J. (1995). Case-mix controlled service use and expenditures in the social health maintenance organization demonstration. Journal of Gerontology: Medical Sciences, 50(1), 111-119.
53.
Nicolaides-Bouman, A., Van Rossum, E., Kempen, G., & Knipschild, P. (2004). Effects of home visits by home nurses to elderly people with health problems: Design of a randomized clinical trial in the Netherlands. BMC Health Services Research , 4(5), 4-35.
54.
Orwin, R. (2000). Assessing program fidelity in substance abuse health services research. Addiction, 95(Suppl. 3), S309-S327.
55.
Ostir, G., Volpato, S., Kasper, J., Ferrucci, L., & Guralnik, J. (2001). Summarizing amount of difficulty in ADLs: A refined characterization of disability. Results from the Women's Health and Aging Study. Aging, 13(6), 465-472.
56.
Probst, J., Samuels, M., Moore, C., & Gdovin, J. (2002). Access to care among rural minorities: Older adults . Columbia, SC: Arnold School of Public Health, Department of Health Administration.
57.
Ritchie, C., Wieland, D., Tully, C., Rowe, J., Sims, R., & Bodner, E. (2002). Coordination and advocacy for rural elders care: A model of rural case management with veterans. Gerontologist , 42(3), 399-405.
58.
Rubenstein, L., & Stuck, A. (2001). Preventive home visits for older people: Defining criteria for success. Age and Ageing, 30(2), 107-109.
59.
Schein, C., Gagnon, A., Chan, L., Morin, I., & Grondines, J. (2005). The association between specific nurse case management interventions and elder health. Journal of the American Geriatric Society, 53(4), 597-602.
60.
Shaughnessy, P., Crisler, K., & Schlenker, R. (1998). Outcome-based quality improvement in home healthcare: The OASIS indicators. Topics in Health Information Management , 18(4), 59-69.
61.
Soldo, B., & Manton, K. (1985). Health status and service needs of the oldest old: Current patterns and future trends. Milbank Quarterly , 63(2), 266-323.
62.
Sommers, L., Marton, K., Barbaccia, J., & Randolph, J. (2000). Physician, nurse, and social worker collaboration in primary care for chronically ill seniors. Archives of Internal Medicine, 160(12), 1825-1833.
63.
Stuck, A., Egger, M., Hammer, A., Minder, C., & Beck, J. (2002). Home visits to prevent nursing home admission and functional decline in elderly people: Systematic review and meta-regression analysis. Journal of the American Medical Association, 287(8), 1022-1028.
64.
Stuck, A., Minder, C., Peter-Wuest, I., Gillman, G., Egli, C., Kesselring, A., et al. (2000). A randomized trial of in-home visits for disability prevention of community-dwelling older people at low and high risk for nursing home admission. Archives of Internal Medicine , 160(7), 977-986.
65.
Stuck, A., Siu, A., Wieland, G., Adams, J., & Rubenstein, L. (1993). Comprehensive geriatric assessment: A meta-analysis of controlled trials. Lancet, 23(8878), 1032-1036.
66.
Thomas, J., & Lichtenstein, R. (1986). Functional health measure for adjusting health maintenance organization capitation rates. Health Care Finance Review, 7(3), 85-95.
67.
Tinetti, M., Baker, D., Gallo, W., Nanda, A., Charpentier, P., & O'Leary, J. (2002). Evaluation of restorative care vs. usual care for older adults receiving an acute episode of home care. Journal of the American Medical Association, 287(16), 2098-2105.
68.
Tinetti, M., Speechley, M., & Ginter, S. (1988). Risk factors for falls among elderly people living in the community. New England Journal of Medicine, 319(26), 1701-1707.
69.
Trojan, M., & Yonge, O. (1993). Developing trusting, caring relationships: Home care nurses and elderly clients. Journal of Advanced Nursing , 18(12), 1903-1910.
70.
Van Haastregt, J., Diederiks, J., Van Rossum, E., de Witte, L., & Crebolder, H. (2000). Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk. British Medical Journal, 321(7237), 754-758.
71.
Van Hout, H., Nijpels, G., van Marwijk, H., Jansenm A., Van Veer, P., Tybout, W., et al. (2005). Design and pilot results of a single blind randomized controlled trial of systematic demand-led home visits by nurses to frail elderly persons in primary care. Bio Medical Central Health Services Research, 5(11), 1-19.
72.
Van Rossum, E., Frederiks, C., Philipsen, H., Portengen, K., Wiskerke, J., & Knipschild, P. (1993). Effects of preventive home visits to elderly people. British Medical Journal, 307(6895), 27-32.
73.
Waldrop, J., & Stern, S. (2000). Disability status 2000. Washington, DC: U.S. Census Bureau.
74.
Wan, T., & Odell, B. (1981). Factors affecting the use of social and health services for the elderly. Ageing and Society, 1, 95-115.
75.
Ware, J., Snow, K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston: The Health Institute, New England Medical Center.
76.
Young, H. (May 31, 2003). Challenges and solutions for care of frail older adults. Online Journal of Issues in Nursing, 8(2), Manuscript 4.
