title: 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.
  
  
  RESULTS
  
  
  
  METHODS
  Ten databases including CENTRAL and Medline searched through December 2012.
  
  
  METHODS
  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.
  
  
  METHODS
  Two authors independently extracted data. Outcomes were pooled using random effects.
  
  
  METHODS
  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.
authors.affiliation: Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London, London, United Kingdom.
authors.forename: Evan
authors.initials: E
authors.lastname: Mayo-Wilson
authors.affiliation: Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.
authors.forename: Sean
authors.initials: S
authors.lastname: Grant
authors.affiliation: Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Burton
authors.affiliation: Yale Law School, New Haven, Connecticut, United States of America.
authors.forename: Amanda
authors.initials: A
authors.lastname: Parsons
authors.affiliation: Yale Law School, Yale Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, United States of America.
authors.forename: Kristen
authors.initials: K
authors.lastname: Underhill
authors.affiliation: Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Montgomery
mesh_terms: D000368:Aged; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D009017:Morbidity; D009026:Mortality