Effectiveness of home based support for older people: systematic review and meta-analysis.
OBJECTIVE
To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people.


METHODS
Systematic review and meta-analysis of 15 studies of home visiting.


METHODS
older people living at home, including frail older people at risk of adverse outcomes.


METHODS
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).


CONCLUSIONS
Home visits to older people can reduce mortality and admission to long term institutional care.
Elkan
R
R
School of Nursing, Postgraduate Division, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH.
Kendrick
D
D
Dewey
M
M
Hewitt
M
M
Robinson
J
J
Blair
M
M
Williams
D
D
Brummell
K
K
D000368:Aged; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000191:economics*; D006760:Hospitalization; D006792:House Calls; D006801:Humans; D008134:Long-Term Care; D011315:Preventive Medicine / Q000379:methods*; D012107:Research Design; D015996:Survival Rate