Dataset Information

Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.

ABSTRACT:

Background

Home 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 findings

Data sources

Ten databases including CENTRAL and Medline searched through December 2012.

Study selection

Randomized 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 synthesis

Two authors independently extracted data. Outcomes were pooled using random effects.

Main outcomes and measures

Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.

Results

Sixty-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.

Conclusions

Home 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.

SUBMITTER: Mayo-Wilson E

PROVIDER: S-EPMC3951196 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.

Mayo-Wilson Evan E Grant Sean S Burton Jennifer J Parsons Amanda A Underhill Kristen K Montgomery Paul P

PloS one 20140312 3

<h4>Background</h4>Home 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.<h4>Methods and findings</h4><h4>Data sources</h4>Ten databases including CENTRAL and Medline searched through December 2012.<h4>Study selection</h4>Randomized controlled trials enrolling community-dwelling persons wi ...[more]

PMID: 24622676

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Project description:BackgroundHome visiting services for older adults have been offered for decades to maintain and promote health and independent functioning, thus enhancing quality of life. Previous systematic reviews have provided a mixed picture of the benefits of home visiting programmes in older adults, primarily because of heterogeneity in study designs, targeted populations, and intervention strategies. These reviews may also become out of date; thus, an updated synthesis of relevant studies is warranted. Our objective is to perform a systematic review of recently published primary studies on the effectiveness of multi-professional home visits on quality of life among older adults.MethodsWe will perform a comprehensive search for studies investigating the effect of a multi-professional home visit approach on quality of life among older adults. We will conduct the literature search in selected electronic databases and relevant research websites from January 2010 onwards. We will include randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies that enrolled older adults without dementia over 60 years old, along with studies involving multi-professional preventive-promotive home visit approaches not related to recent hospital discharge. We will report our planned review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will retrieve and record relevant data in a standardised data extraction form and evaluate the quality of the included articles using the Cochrane risk of bias tool and the quality assessment tool for studies with diverse designs (QATSDD). Where appropriate, outcomes will be pooled for meta-analysis using a random-effects model. The main outcomes include quality of life, incidence of falls, depression, dementia, and emergency department admissions.DiscussionThis review may provide evidence for the effectiveness of home visits in improving older adults' quality of life. It will potentially benefit health care professionals, policymakers, and researchers by facilitating the design and delivery of interventions related to older generations and improve service delivery in future.Systematic review registrationPROSPERO CRD42021234531 .

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.

Dataset Information

Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.

Background

Methods and findings

Data sources

Study selection

Data extraction and synthesis

Main outcomes and measures

Results

Conclusions

Publications

Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.

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