Dataset Information

Preventive home visits postpone mortality--a controlled trial with time-limited results.

ABSTRACT:

Background

There is a debate on whether preventive home visits to older people have any impact. This study was undertaken to investigate whether preventive home visits by professional health workers to older persons can postpone mortality in a Swedish context.

Method

A controlled trial in a small community in the north of Sweden. Participants are healthy pensioners aged 75 years and over. 196 pensioners were selected as the intervention group and 346 as the control group. The intervention, two visits per year, lasted two years.

Results

During the intervention, mortality was 27 per 1000 in the intervention group and 48 per 1000 in the control group. The incidence rate ratio for the control group IR2000-2001 was 1.79 (95% CI = 0.94-3.40). Analysing the data with an "on treatment approach" gave a significant result, 2.31 (95% CI = 1.07-5.02) After the trial the difference between the groups disappeared.

Conclusion

Preventive home visits in a healthy older population can postpone mortality in a Swedish context if they are carried out by professional health-workers in a structured way. When the home visit programme ended the effect on mortality disappeared. These findings are dependent on contextual factors that make it difficult to form general policy recommendations.

SUBMITTER: Sahlen KG

PROVIDER: S-EPMC1584405 | biostudies-literature | 2006 Aug

REPOSITORIES: biostudies-literature

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Publications

Preventive home visits postpone mortality--a controlled trial with time-limited results.

Sahlen Klas-Göran KG Dahlgren Lars L Hellner Britt Mari BM Stenlund Hans H Lindholm Lars L

BMC public health 20060831

<h4>Background</h4>There is a debate on whether preventive home visits to older people have any impact. This study was undertaken to investigate whether preventive home visits by professional health workers to older persons can postpone mortality in a Swedish context.<h4>Method</h4>A controlled trial in a small community in the north of Sweden. Participants are healthy pensioners aged 75 years and over. 196 pensioners were selected as the intervention group and 346 as the control group. The inte ...[more]

PMID: 16945128

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Project description:BackgroundThe search for preventive methods to mitigate functional decline and unwanted relocation by older adults living in the community is important. Preventive home visit (PHV) models use infrequent but regular visits to older adults by trained practitioners with the goal of maintaining function and quality of life. Evidence about PHV efficacy is mixed but generally supportive. Yet interventions have rarely combined a comprehensive (biopsychosocial) occupational therapy intervention protocol with a home visit to older adults. There is a particular need in the USA to create and examine such a protocol.Methods/designThe study is a single-blind randomized controlled pilot trial designed to assess the feasibility, and to obtain preliminary efficacy estimates, of an intervention consisting of preventive home visits to community-dwelling older adults. An occupational therapy-based preventive home visit (PHV) intervention was developed and is being implemented and evaluated using a repeated measures design. We recruited a sample of 110 from a population of older adults (75+) who were screened and found to be at-risk for functional decline. Participants are currently living in the community (not in assisted living or a skilled nursing facility) in one of three central North Carolina counties. After consent, participants were randomly assigned into experimental and comparison groups. The experimental group receives the intervention 4 times over a 12 month follow-up period while the comparison group receives a minimal intervention of mailed printed materials. Pre- and post-intervention measures are being gathered by questionnaires administered face-to-face by a treatment-blinded research associate. Key outcome measures include functional ability, participation, life satisfaction, self-rated health, and depression. Additional information is collected from participants in the experimental group during the intervention to assess the feasibility of the intervention and potential modifiers. Fidelity is being addressed and measured across several domains.DiscussionFeasibility indications to date are positive. Although the protocol has some limitations, we expect to learn enough about the intervention, delivery and effects to support a larger trial with a more stringent design and enhanced statistical power.Trial registrationClinicalTrials.gov ID NCT00985283.

Project description:BackgroundRegarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial.MethodsThe trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session. The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160). Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective.DiscussionTo the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.

Project description:BackgroundHome visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services.Methods and findingsData sourcesTen databases including CENTRAL and Medline searched through December 2012.Study selectionRandomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge.Data extraction and synthesisTwo authors independently extracted data. Outcomes were pooled using random effects.Main outcomes and measuresMortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.ResultsSixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk?=?0.93 [0.87 to 0.99]; absolute risk?=?0.00 [-0.01 to 0.00]). There was moderate quality evidence of no overall effect on the number of people institutionalized (RR?=?1.02 [0.88 to 1.18]) or hospitalized (RR?=?0.96 [0.91 to 1.01]). There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio?=?0.86 [0.73 to 1.01]), but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference?=?-0.06 [-0.11 to -0.01]) and physical functioning (SMD?=?-0.10 [-0.17 to -0.03]) respectively, but these may not be clinically important.ConclusionsHome visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting of intervention components and delivery, we cannot exclude the possibility that some programs may be effective.

Dataset Information

Preventive home visits postpone mortality--a controlled trial with time-limited results.

Background

Method

Results

Conclusion

Publications

Preventive home visits postpone mortality--a controlled trial with time-limited results.

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