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Effectiveness of home based support for older people: systematic review and meta-analysis
1School of Nursing, Postgraduate Division, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH.
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 institutional 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.
