Competencias del enfermero en torno a la promoción de la salud de ancianos en domicilio

Leandro, Telma Alteniza; Alves, Allana Mirella; Pinheiro, Ana Karina Bezerra; Araujo, Thelma Leite de; Quirino, Glauberto da Silva; Oliveira, Dayanne Rakelly de

doi:10.1590/0034-7167-2018-0446

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Brasil

Revista Brasileira de Enfermagem

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Brasil

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Sumário

REVIEW • Rev. Bras. Enferm. 72 (suppl 2) • Nov 2019 • https://doi.org/10.1590/0034-7167-2018-0446 copiar

Competencias del enfermero en torno a la promoción de la salud de ancianos en domicilio

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

identificar en la literatura las competencias del enfermero relacionadas a la promoción de la salud de ancianos en domicilio.

Método:

revisión sistemática realizada en las bases de datos LILACS, Scopus, CINAHL, portal PubMed y biblioteca Cochrane, en noviembre de 2017. Se hizo el análisis de los artículos seleccionados a partir de nueve dominios de competencias: permitir el cambio; preservar la salud; intermediar mediante asociación; comunicarse; liderar; evaluar; planificar; aplicar; y evaluar e investigar.

Resultados:

se incluyeron nueve ensayos clínicos. Se identificaron todos los dominios de las competencias en torno a la promoción de la salud en las intervenciones realizadas en las encuestas con los ancianos residentes en domicilio.

Conclusión:

los estudios demostraron que los tratamientos utilizados fueron beneficiosos para la población de ancianos en domicilio, y que las intervenciones con base en las competencias para promover la salud pueden ser identificadas, además de establecer una práctica asistencial eficaz y de calidad.

Descriptores:
Anciano; Personas Imposibilitadas; Competencia Profesional; Enfermería; Promoción de la Salud

Reference and place of study	Design/number of participants	Intervention	Outcome
Tuntland et al.⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ⁾, 2015 Norway	- Sixty-one older people with functional capacity decline. CG: 30 (49.2%) IG: 31 (50.8%)	CG: Conventional care (assistance, patient safety alarm, meals, assistive technology and rehabilitation with therapists). IG: Multicomponent rehabilitation (identification of limitations imposed on important activities, supervision of caregivers, training for daily activities, environmental adaptations, and exercise programs).	Significant mean-score improvements in occupational performance, favoring rehabilitation. There were no significant differences between the groups in any of the secondary outcomes after 3 or 9 months; however, both groups improved in regards to mobility and balance, as well as most health-related quality of life domains. These effects were sustained in the 9-month follow-up.
Gellis, Kenaley, Have⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ⁾, 2014 United States	- Ninety-four clinically frail elderly individuals ≥ 65 years old with a history of hospitalization in the last 6 months, or who needed home care visits ≥ 3 times per week; all were positively screened for depression.CG: 46 (48.9%)IG: 48 (51.1%)	CG: Habitual care provided by home nurses via home visits and psychotherapy. IG: Integrated telehealth intervention consisting of telemonitoring, chronic disease management, and treatment for depression.	The groups had marked symptoms of depression. At 3 months, the integrated telehealth group exhibited less depression than the CG, and the trend continued at 6 months. At 3 and 6 months, no significant physical health status differences were found when comparing both groups. Scores at 3 months suggest that the IG exhibited greater problem-solving skills.
Kono et al.⁽¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ⁾ , 2013 Japan	- Three hundred and seven participants aged ≥ 65 years, homebound, supported by health insurance. CG: 153 (49.8%) IG: 154 (50.2%)	CG: Frail elderly, accompanied at outpatient clinics. IG: Frail elderly, accompanied at outpatient clinics, who had received home visits from nurses.	The average costs of health care during the study's 2-year period decreased slightly in the group who had received home visits as compared to the CG, but the difference was not significant. For most months, financial costs in the IG were lower than in the CG; considering the 2-year period, both groups had similar average costs of hospital care. Hospitalizations were less likely to occur in the IG.
Gellis et al.⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ , 2012 United States	- A hundred and two older people ≥ 65 years of age, suffering from CHF or COPD, who were hospitalized at least twice in the last 6 months, or who visited the emergency room at least twice in the last 2 months. CG: 51 (50%) IG: 51 (50%)	CG: Conventional home care and health education. IG: Telehealth intervention; monitoring system in which patients were made aware of normal clinical parameters and instructed on when to contact the health nurse. The nurse was available to the patient daily, able to be contacted via telephone, and also able to perform urgent home visits whenever needed.	At 3 months, IG patients' scores for symptoms of depression improved significantly when compared to the CG. The telehealth group experienced significantly greater increases in two of the three SF-36 scales (general health and social functioning). The satisfaction with care survey showed that both groups were satisfied with their care, without significant differences. The CG had significantly more visits to the emergency room than the IG.
Shearer, Fleury, Belyea⁽¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ⁾, 2010 United States	- Forty-two individuals aged ≥ 60 years, who spoke and understood English, had good hearing and well-preserved cognitive functions. CG: 22 (52.4%) IG: 20 (47.6%)	CG: Weekly bulletins were sent out to the CG, providing information on home safety, medication safety, aging and skin care, aging and vision, dental care, and bone health. IG: Health empowerment intervention based on six integrated components (personal resources and building selfcapacity; building self-capacity through the recognition of one's strengths, selftalk, purpose in life, personal growth, and self-acceptance; recognizing and building social networks; identifying and building social service utilization; communicating to build social networks and access social service providers; and reviewing goals for the future). The intervention was carried out during home visits by a trained nurse.	At the 6th and 12th weeks, the IG presented a significantly higher goal achievement score. According to the employed theoretical framework, there was no significant main effect on health empowerment. However, the personal growth subscale had a significant increase when comparing the beginning of the intervention and the 12-week point. All in all, the IG showed more personal growth than the CG. In the well-being scale, there were no significant main effect differences among groups. However, there were significant differences among the oldest participants, with a well-being increase in the IG taking place between the 6-week and the 12-week points. There was no main effect over the total score of the scale from: evaluating feelings about awareness, choices, freedom to act intentionally, and involvement in creating change. However, men in the IG showed significant differences in this regard.
20. Boyd et al.⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ , 2008 United States	- 150 older people with high-risk chronic diseases. High-risk patients are those most likely to need health services. CG: 63 (76%) IG: 31 (41 %)	CG: Received usual health care. IG: Received guided health care.	In comparison to the CG, the IG showed a tendency of improved quality of communication between patient and professional, as well as a more comprehensive knowledge. There were no differences for integration of care, interpersonal treatment, and trust in physician.
Vass et al.⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾ , 2009 Denmark	- Four thousand and thirty-four older people, home-dwelling, aged 75 or 80 years.CG: 1942 (48.1%)IG: 2092 (51.9%)	CG: The population belonging to the control municipalities received usual care. Professionals from these municipalities did not participate in any training. IG: The population belonging to intervention municipalities was assisted by professionals who had received educational training.	Intervention was not associated with mortality in both groups. During 4 and a half years of follow-up, 63 75-year olds from the intervention municipalities moved to nursing homes, compared to 62 in the control municipalities. Among 80-year olds, 38 moved to nursing homes in the intervention municipalities, as compared to 48 in the control municipalities. The hospitalization rates were lower in the 80-year-old participants of the intervention municipalities. Three years of intervention improved functional capacity in 80-year-old participants.
Engberg et al.⁽²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾, 2002 United States	- Sixteen homebound individuals aged ≥ 60 years, suffering from at least two urinary incontinence episodes per week persisting for at least 3 months. They had cognitive impairment and were assisted by caregivers.CG: 10 (62.5%)IG: 6 (37.5%)	CG: Received visits from nurses to improve urination control. Subjects and their caregivers were aware that they were in a study examining the effectiveness of a UI program, but there was no discussion of incontinence or its treatment with the caregiver or subject during the nurse's visits.IG: The treatment consisted of nurse-oriented behavioral therapy and scheduled urination performed with the help of caregivers, for 8 weeks. There were no interventions during the night.	There was a mean reduction of 50% in daytime incontinence episodes compared to 37% in the control group. The average daily percentage of wet diapers or underwear fell by 43%, compared to 35% in the control group. Treated patients had a 55% decrease in all episodes of incontinence (day and night) compared to 27% in the control group.
McDowell et al.⁽²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ , 1999 United States	- A hundred and five cognitively intact, home-dwelling individuals aged ≥ 60 years, reporting at least two urinary losses per week persisting for at least 3 months.CG: 52 (49.5%)IG: 53 (50.5%)	CG: Nurse visits to provide social interaction without specifications for UI treatment, aiming to evaluate the effects of socialization. Bladder diaries were not filled during control. Each visit had 35 minutes. Visits were carried out for 8 weeks.IG: Biofeedback-assisted pelvic floor muscle exercises, urge and stress strategies, and bladder retraining. The bladder diary was assessed weekly, and treatment was adjusted based on the patient's evolution. Forty to sixty-minute visits, for 8 weeks.	The mean number of incontinence episodes per day decreased from 4.1 to 3.5 in the CG. In the IG, it decreased from 4.0 to 1.8. Thus, treated subjects presented a significant reduction of urinary losses per day (P ≤ 1).

CompHP domains	Nursing interventions
Enable Change	Promote empowerment⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^-¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^-¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Promote health education⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ Facilitate the development of skills⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Professional training⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾
Advocate for Health	Improve health⁽²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Enable therapeutic adherence⁽²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Facilitate access to community assets⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Enable cost reduction⁽¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ⁾ Influence stakeholders for change⁽¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Raise awareness on health issues⁽¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ⁾ Stimulus for the use of social resources⁽¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ⁾
Mediate through Partnership	Partnership with older people and caregivers⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Collaborative working⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Partnership with the community⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Partnership with other professionals⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾ Partnership with municipalities and administrators⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾
Communication	Visits at home⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... 17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... 18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^-¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... 22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Written recommendations and illustrated material⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Use of information technology⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Communication instruments (telephone, tape recorder)⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^-²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Motivational interview⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Use of telehealth technology⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ Meetings⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾
Leadership	Incorporate new knowledge⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... 22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Supervision and training⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^-¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ Encourage participants to make changes⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ⁾ Facilitate empowerment and participation⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾
Assessment	Identify existing limitations⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Identifying the health needs of patients⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^,²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Identify priorities for health promotion actions⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^-¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Multidimensional and individualized evaluation⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^-¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ⁾ Daily assessment of patient data⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾
Planning	Develop a feasible action plan⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^-¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Schedule actions⁽¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾
Implementation	Develop empowerment actions⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Implement behavioral intervention⁽²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Promote strategies for access to community services⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Employ assets (scales, instruments)⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... 16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^-¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^-²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾ Develop custom asset⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Repeat instructions for therapy maintenance activities⁽²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾ Follow-up over a certain time period⁽¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^-²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Use of telehealth technology⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ Management and treatment of depression⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ⁾
Evaluation and Research	Evaluate interventions' results⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... 16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... 17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... 18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... 19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... 20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... 21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... 22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Reassessment of participants at end of treatment⁽²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾

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[1] Corresponding Author: Telma Alteniza Leandro. E-mail: telmaleandro21@yahoo.com.br