Preventive home visits to older people

Preventative home visits are aimed at maintaining the independence and health of older people living in their own homes without home care. The content of the home visits can vary between different organisations and countries.

Question

What systematic reviews are published on preventive home visits for older people?

Identified literature

Tabell 1. Systematiska översikter med låg/måttlig risk för bias/Table 1. Systematic reviews with low/medium risk of bias
NHS = National health services in the United kingdoms; PHV = Preventive home visits; QOL = Quality-of-life.
Included studies Population/Intervention Outcome
Liimatta et al (2016) [1]
Study design:
Included only randomized control studies (RCT).
Selection of studies:
Search resulted in 3219 abstracts and synthesis included 19 papers.
Population:
Community-dwelling older people (Aged 65+) with multiple health problems.
Studies targeting people with one specific disease or diagnosis were excluded.
Intervention:
Preventive home visiting programs.
Studies evaluating follow-up home visits related to a recent hospital discharge where excluded.
Primary outcomes:
Use- and/or costs of health care and social services.
Secondary outcomes:
Functioning, Quality-of-life (QOL), and Mortality.
Authors' conclusion:
“Only a few studies explored economic effects. PHVs do not provide overall savings to health care costs, but come interventions might offer some cost-neutral positive effects on functioning, QOL and/or mortality. More studies are needed to clarify the effective aspects of the programs and cost-effectiveness of the PHVs”
Tourigny et al (2015) [2]
Study design:
Included systematic reviews (SR) or SR of systematic reviews of controlled primary studies.
Selection of studies:
Search resulted in 5973 abstracts and the synthesis included 10 reviews.
Population:
Older people (Aged 65+) needing home care and identified as frail.
Intervention:
Preventive home visits approaches or models.
Coordinating programs between providers were included as long they were carried out in participants home.
Primary outcomes:
All impacts on patients (including but not limited to mortality and function), caregivers (health and wellbeing) and on professionals; as well as on use of services and organization of care.
Authors' conclusion:
“The evidence gathered in this systematic review of systematic reviews is relatively scarce and often inconclusive. In that sense, we generally agree with other authors that multidimensional preventive home visiting programs present conflicting results on most outcomes. We nevertheless found that this type of program might reduce mortality, in particular for the participants in the youngest tertile”
Grant et al (2014) [3]
Study design:
Included randomized controlled trials (RCTs) and clustered RCTs.
Selection of studies:
Search resulted in 18784 abstracts and the synthesis included 89 papers.
Population:
Older people (Aged 65+) who were living at home (alone or with a partner).
Studies which more than 50% of participants had dementia were excluded.
Intervention:
Visits at home by a health or social care professional.
Studies evaluating follow-up home visits directly related to a recent hospital discharge were excluded.
Primary outcomes:
Mortality
Secondary outcomes:
Institutionalisation, Hospitalisation, Falls, Injuries, Physical functioning, Cognitive functioning, Quality of life, Psychiatric illness.
Authors' conclusion:
“We were unable to identify reliable effects of home visits overall or in any subset of studies In this review. It is possible that some home visiting programmes have beneficial effects for community-dwelling older adults, but poor reporting of how interventions and comparisons were implemented prevents more robust conclusions.”
Tappenden et al (2012) [4]
Study design:
Clinical effectiveness: Included randomized controlled trials (RCTs). Non-randomized studies were excluded.
Cost-effectiveness: Included full comparative economic evaluations that presents both costs and health outcomes.
Selection of studies:
Clinical effectiveness: Search resulted in 2068 abstracts and the synthesis included 11 papers.
Cost-effectiveness: Search resulted in 1988 abstracts and the synthesis included 3 papers.
Population:
Older people (Aged 75+) at risk of admission to hospital, residential or nursing care.
Intervention:
Structured home-based, nurse-led health promotion undertaken in the UK.
Primary outcomes:
Admission to hospital, residential or nursing care, mortality, morbidity including depression, falls, accidents, deteriorating health status, patient satisfaction, costs.
Authors' conclusion:
“Home-based, nurse-led health promotion may offer clinical benefits across a number of important health dimensions. However, it is generally unclear from the available studies which components of this type of complex intervention contribute towards individual aspects of benefit for older people. Given the limitations of the current evidence base, it remains unclear whether or not home-based health promotion interventions offer good value for money for the NHS and associated sectors.”

References

  1. Liimatta H, Lampela P, Laitinen-Parkkonen P, Pitkala KH. Effects of preventive home visits on older people's use and costs of health care services: A systematic review. Eur Geriatr Med 2016;7:571-80.
  2. Tourigny A, Bédard A, Laurin D, Kröger E, Dur P, et al. Preventive Home Visits for Older People: A Systematic Review. Can J Aging 2015;34:506-23.
  3. Grant S, Parsons A, Burton J, Montgomery P, Underhill K, Wilson EM. Home Visits for Prevention of Impairment and Death in Older Adults: A Systematic Review. Campbell Systematic Reviews 2014;10:1-85.
  4. Tappenden P, Campbell F, Rawdin A, Wong R, Kalita N. The clinical effectiveness and cost-effectiveness of home-based, nurse-led health promotion for older people: a systematic review. Health Technol Assess 2012;16:1-72.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 2/4/2020
Contact SBU: registrator@sbu.se
Report no: ut202004
Registration no: SBU 2020/23