Effects of preventive home visits to elderly people

To assess the effect of preventive home visits by public health nurses on the state of health of and use of services by elderly people living at home.

Randomised controlled trial.

General population of elderly people in one of the southern regions of the Netherlands.

580 subjects aged between 75 and 84 years randomly allocated to intervention (292) or control (288) group.

Four visits a year over three years in intervention group. Control group received no home visits.

Self rated health, functional state, well being, loneliness, aspects of the mental state (depressive complaints, memory disturbances), and mortality. Use of services and costs.

Visits had no effect on the health of the subjects. In the group visited no higher scores were seen on health related measures, fewer died (42 (14%) v 50 (17%)), and community care increased slightly. In the control group more were referred to outpatient clinics (166 (66%) v 132 (55%)), and they had a 40% increased risk of admission (incidence rate ratio 1.4; 90% confidence interval 1.2 to 1.6). No differences were found in long term institutional care, and overall expenditure per person in the intervention group exceeded that in the control group by 4%. Additional analyses showed that visits were effective for subjects who initially rated their health as poor.

Preventive home visits are not beneficial for the general population of elderly people living at home but might be effective when restricted to subjects with poor health.