Effectiveness of home based support for older people: systematic review and meta-analysis.

Abstract Objective: To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. Design: Systematic review and meta-analysis of 15 studies of home visiting. Participants: Older people living at home, including frail older people at risk of adverse outcomes. Outcome measures: Mortality, admission to hospital, admission to institutional care, functional status, health status. Results: Home visiting was associated with a significant reduction in mortality. The pooled odds ratio for eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, “at risk” older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardised effect size 0.06; −0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; −0.07 to 0.17). Conclusion: Home visits to older people can reduce mortality and admission to long term institutional care. What is already known on this topic The benefits of regular, preventive home visits to older people are the subject of controversy A recent systematic review found no clear evidence that preventive home visits were effective What this study adds This meta-analysis of 15 trials shows that home visiting can reduce mortality and admission to institutional care among older people

[1]  G. Gutman,et al.  Randomized Trial of a Health Promotion Program For Frail Elders , 1992, Canadian Journal on Aging / La Revue canadienne du vieillissement.

[2]  J. Oktay,et al.  Post-hospital support program for the frail elderly and their caregivers: a quasi-experimental evaluation. , 1990, American journal of public health.

[3]  J. McCusker,et al.  A randomized controlled study of a home health care team. , 1985, American journal of public health.

[4]  J. Rowe.  Health care of the elderly. , 1985, The New England journal of medicine.

[5]  L. Groom,et al.  The care of people over 75 years old after discharge from hospital: an evaluation of timetabled visiting by Health Visitor Assistants. , 1992, Journal of public health medicine.

[6]  C. Hendriksen,et al.  Consequences of assessment and intervention among elderly people: a three year randomised controlled trial. , 1984, British medical journal.

[7]  L. Rubenstein,et al.  Comprehensive geriatric assessment: a meta-analysis of controlled trials , 1993, The Lancet.

[8]  J. G. Walker,et al.  Medical and Social Screening of Patients aged 70 to 72 by an Urban General Practice Health Team , 1974, British medical journal.

[9]  B. Adams-Huet,et al.  The Effect of Geriatric Evaluation and Management on Medicare Reimbursement in a Large Public Hospital: A Randomized Clinical Trial , 1992, Journal of the American Geriatrics Society.

[10]  J. Marley,et al.  Preventive home visits to elderly people in the community , 2000, BMJ : British Medical Journal.

[11]  P. Knipschild,et al.  Effects of preventive home visits to elderly people. , 1993, BMJ.

[12]  M. Tinetti,et al.  A multifactorial intervention to reduce the risk of falling among elderly people living in the community. , 1994, The New England journal of medicine.

[13]  Carlson Bl,et al.  Follow-up study of an urban family medicine home visit program. , 1988 .

[14]  N. Vetter,et al.  Can health visitors prevent fractures in elderly people? , 1992, BMJ.

[15]  Diana B. Petitti,et al.  Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis: Methods for Quantitative Synthesis in Medicine , 1994 .

[16]  G. Smith,et al.  1 Rationale, potentials, and promise of systematic reviews , 2001 .

[17]  Suzanne G. Leveille,et al.  Preventing disability and falls in older adults: a population-based randomized trial. , 1994, American journal of public health.

[18]  G. Carpenter,et al.  Screening the elderly in the community: controlled trial of dependency surveillance using a questionnaire administered by volunteers. , 1990, BMJ.

[19]  L. Rubenstein,et al.  An In‐Home Preventive Assessment Program for Independent Older Adults: A Randomized Controlled Trial , 1994, Journal of the American Geriatrics Society.

[20]  P. Pearson,et al.  Screening elderly people in primary care: a randomized controlled trial. , 1990, The British journal of general practice : the journal of the Royal College of General Practitioners.

[21]  J. Brocklehurst.  Health visiting and the elderly--a geriatrician's view. , 1982, Health visitor.

[22]  Douglas G. Altman,et al.  Systematic Reviews in Health Care: Meta-Analysis in Context: Second Edition , 2008 .

[23]  J. Tyson,et al.  Aid to the evaluation of therapeutic studies. , 1989, Pediatrics.

[24]  L. D. de Witte,et al.  Effects of preventive home visits to elderly people living in the community: systematic review , 2000, BMJ : British Medical Journal.

[25]  A O Frank,et al.  Oman: leaping across the centuries. , 1988, BMJ.

[26]  N. Vetter.  Effect of health visitors working with elderly patients in general practice: randomised controlled trials , 1984, British medical journal.

[27]  R. Jones,et al.  Health visitor intervention to reduce days of unplanned hospital re-admission in patients recently discharged from geriatric wards: the results of a randomised controlled study. , 1994, Archives of gerontology and geriatrics.

[28]  A. Bayer,et al.  Randomised trial of case finding and surveillance of elderly people at home , 1992, The Lancet.

[29]  L. Rubenstein,et al.  A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. , 1995, The New England journal of medicine.

[30]  L. Hedges.  Estimation of effect size from a series of independent experiments. , 1982 .

[31]  B. Stewart,et al.  The PREP system of nursing interventions: a pilot test with families caring for older members. Preparedness (PR), enrichment (E) and predictability (P). , 1995, Research in nursing & health.

[32]  R. Coupland.  Effective health visiting for elderly people. , 1986, Health visitor.

[33]  K. H. Sørensen,et al.  Follow-up three years after intervention to relieve unmet medical and social needs of old people. , 1988, Comprehensive gerontology. Section B, Behavioural, social, and applied sciences.

[34]  R. Hanka.  The Handbook of Research Synthesis , 1994 .

[35]  V. Moore,et al.  A randomized controlled trial of geriatric screening and surveillance in general practice. , 1979, The Journal of the Royal College of General Practitioners.

[36]  M. Schroll,et al.  Geriatric follow-up by home visits after discharge from hospital: a randomized controlled trial. , 1992, Age and ageing.

[37]  Jonathan A C Sterne,et al.  Sifting the evidence—what's wrong with significance tests? , 2001, BMJ : British Medical Journal.

[38]  J. Ramsdell,et al.  The Yield of a Home Visit in the Assessment of Geriatric Patients , 1989, Journal of the American Geriatrics Society.

[39]  A. Stuck,et al.  A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. , 2000, Archives of internal medicine.

[40]  L O Bygren,et al.  Efficacy of the Rehabilitation of Elderly Primary Health Care Patients After Short-Stay Hospital Treatment , 1992, Medical care.