Effects of intensive home visiting programs for older people with poor health status: a systematic review

Ans Bouman, Erik van Rossum, Patricia Nelemans, Gertrudis Ijm Kempen, Paul Knipschild, Ans Bouman, Erik van Rossum, Patricia Nelemans, Gertrudis Ijm Kempen, Paul Knipschild

Abstract

Background: Home visiting programs have been developed aimed at improving the health and independent functioning of older people. Also, they intend to reduce hospital and nursing home admission and associated cost. A substantial number of studies have examined the effects of preventive home visiting programs on older people living in the community; the findings have been inconsistent. The objective of this review was to assess the effectiveness of intensive home visiting programs targeting older people with poor health or otherwise with functional impairments.

Methods: A search for literature was based on included trials from four reviews on the effectiveness of home visits published after 2000 and on a database search of Cinahl, the Cochrane Central Register of Controlled Trials, Embase, Medline and PsycINFO from 2001 onwards. We also manually searched reference lists from potentially relevant papers. Randomized controlled trials were included assessing the effectiveness of intervention programs consisting of at least four home visits per year, an intervention duration of 12 months or more, and targeting older people (aged 65 years and over) with poor health. Two reviewers independently abstracted data from full papers on program characteristics and outcome measures; they also evaluated the methodological quality.

Results: The search identified 844 abstracts; eight papers met the inclusion criteria. Seven trials were of sufficient methodological quality; none of the trials showed a significant favorable effect for the main analysis comparing the intervention group with the control group on mortality, health status, service use or cost. The inclusion of less-intensive intervention programs for frail older persons would not have exerted a great influence on the findings of our review.

Conclusion: We conclude that home visiting programs appear not to be beneficial for older people with poor health within the health care setting of Western countries.

Figures

Figure 1
Figure 1
Progress of search for relevant trials.

References

    1. van Haastregt JC, Diederiks JP, van Rossum E, de Witte LP, Crebolder HF. Effects of preventive home visits to elderly people living in the community: systematic review. BMJ. 2000;320:754–758. doi: 10.1136/bmj.320.7237.754.
    1. Elkan R, Kendrick D, Dewey M, Hewitt M, Robinson J, Blair M, Williams D, Brummell K. Effectiveness of home based support for older people: systematic review and meta-analysis. British Medical Journal. 2001;323:719–725. doi: 10.1136/bmj.323.7315.719.
    1. Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002;287:1022–1028. doi: 10.1001/jama.287.8.1022.
    1. Meinck M, Lubke N, Lauterberg J, Robra BP. [Preventive home visits to the elderly: systematic review of available evidence] Gesundheitswesen. 2004;66:732–738. doi: 10.1055/s-2004-813779.
    1. Markle-Reid M, Browne G, Weir R, Gafni A, Roberts J, Henderson SR. The effectiveness and efficiency of home-based nursing health promotion for older people: a review of the literature. Med Care Res Rev. 2006;63:531–569. doi: 10.1177/1077558706290941.
    1. Elkan R, Kendrick D. What is the effectivess of home visiting or homebased support for older people? 2004.
    1. Ploeg J, Feightner J, Hutchison B, Patterson C, Sigouin C, Gauld M. Effectiveness of preventive primary care outreach interventions aimed at older people: meta-analysis of randomized controlled trials. Can Fam Physician. 2005;51:1244–1245.
    1. van Rossum E, Frederiks CM, Philipsen H, Portengen K, Wiskerke J, Knipschild P. Effects of preventive home visits to elderly people. BMJ. 1993;307:27–32.
    1. van Rossum E. Effects of preventive home visits to the elderly. Maastricht , PhD Thesis Maastricht University; 1993. pp. 51–72.
    1. Nicolaides-Bouman A, van Rossum E, Kempen GI, Knipschild P. Effects of home visits by home nurses to elderly people with health problems: design of a randomised clinical trial in the Netherlands [ISRCTN92017183] BMC Health Serv Res. 2004;4:35. doi: 10.1186/1472-6963-4-35.
    1. Nicolaides-Bouman A, van Rossum E, Habets H, Kempen GI, Knipschild P. Home visiting programme for older people with health problems: process evaluation. J Adv Nurs. 2007;58:425–435. doi: 10.1111/j.1365-2648.2007.04235.x.
    1. Bouman A, van Rossum E, Ambergen T, Kempen G, Knipschild P. Effects of a home visiting programme for older people with poor health status: a randomised clinical trial in the Netherlands. J Am Geriatr Soc. 2008;56:397–404. doi: 10.1111/j.1532-5415.2007.01565.x.
    1. Bouman A, van Rossum E, Evers S, Ambergen T, Kempen G, Knipschild P. Multidimensional geriatric assessment: back to the future effects on health care use and associated cost of a home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands. J Gerontol A Biol Sci Med Sci. 2008;63:291–297.
    1. Bula CJ, Berod AC, Stuck AE, Alessi CA, Aronow HU, Santos Eggimann B, Rubenstein LZ, Beck JC. Effectiveness of preventive in-home geriatric assessment in well functioning, community-dwelling older people: secondary analysis of a randomized trial. J Am Geriatr Soc. 1999;47:389–395.
    1. Stuck AE, Minder CE, Peter Wuest I, Gillmann G, Egli C, Kesselring A, Leu RE, Beck JC. A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Arch Intern Med. 2000;160:977–986. doi: 10.1001/archinte.160.7.977.
    1. Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V, Rubenstein LZ, Carbonin P. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ. 1998;316:1348–1351.
    1. van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine. 1997;22:2323–2330. doi: 10.1097/00007632-199710150-00001.
    1. van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 1999;24:1113–1123. doi: 10.1097/00007632-199906010-00011.
    1. van Hout HP, Nijpels G, van Marwijk HW, Jansen AP, Van't Veer PJ, Tybout W, Stalman WA. Design and pilot results of a single blind randomized controlled trial of systematic demand-led home visits by nurses to frail elderly persons in primary care [ISRCTN05358495] BMC Geriatr. 2005;5:11. doi: 10.1186/1471-2318-5-11.
    1. Hall N. Randomized trial of a health promotion program for frail elders. Canadian Journal on Aging/La Revue Canadienne du vieillissement. 1992;11:72–91.
    1. Dalby DM, Sellors JW, Fraser FD, Fraser C, van Ineveld C, Howard M. Effect of preventive home visits by a nurse on the outcomes of frail elderly people in the community: a randomized controlled trial. CMAJ. 2000;162:497–500.
    1. Yamada Y, Ikegami N. Preventive home visits for community-dwelling frail elderly people based on Minimum Data Set-Home Care: Randomized controlled trial. Geriatrics and Gerontology International. 2003;3:236–242. doi: 10.1111/j.1444-1586.2003.00103.x.
    1. van Haastregt JC, Diederiks JP, van Rossum E, de Witte LP, Voorhoeve PM, Crebolder HF. Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial.[comment] British Medical Journal. 2000;321:994–998. doi: 10.1136/bmj.321.7267.994.
    1. van Haastregt JC. Preventing falls and mobility impairments in elderly people living in the community. Maastricht , PhD thesis Maastricht University; 2002. p. 135.
    1. van Haastregt JC, van Rossum E, Diederiks JP, de Witte LP, Voorhoeve PM, Crebolder HF. Process-evaluation of a home visit programme to prevent falls and mobility impairments among elderly people at risk. Patient Education and Counseling. 2002;47:301–309. doi: 10.1016/S0738-3991(02)00003-4.
    1. Cochrane Handbook for Systematic Reviews of Interventions. Chicester , Wiley; 2005.
    1. Williams EI, Greenwell J, Groom LM. The care of people over 75 years old after discharge from hospital: an evaluation of timetabled visiting by Health Visitor Assistants. J Public Health Med. 1992;14:138–144.
    1. Nikolaus T, Bach M. Preventing falls in community-dwelling frail older people using a home intervention team (HIT): results from the randomized Falls-HIT trial. J Am Geriatr Soc. 2003;51:300–305. doi: 10.1046/j.1532-5415.2003.51102.x.
    1. Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331:821–827. doi: 10.1056/NEJM199409293311301.
    1. Hansen FR, Spedtsberg K, Schroll M. Geriatric follow-up by home visits after discharge from hospital: a randomized controlled trial. Age Ageing. 1992;21:445–450. doi: 10.1093/ageing/21.6.445.
    1. Markle-Reid M, Weir R, Browne G, Roberts J, Gafni A, Henderson S. Health promotion for frail older home care clients. J Adv Nurs. 2006;54:381–395. doi: 10.1111/j.1365-2648.2006.03817.x.
    1. Pathy MS, Bayer A, Harding K, Dibble A. Randomised trial of case finding and surveillance of elderly people at home. Lancet. 1992;340:890–893. doi: 10.1016/0140-6736(92)93294-W.
    1. Balaban DJ, Goldfarb NI, Perkel RL, Carlson BL. Follow-up study of an urban family medicine home visit program. Journal of Family Practice. 1988;26:307–312.
    1. Dunn RB, Lewis PA, Vetter NJ, Guy PM, Hardman CS, Jones RW. Health visitor intervention to reduce days of unplanned hospital re-admission in patients recently discharged from geriatric wards: the results of a randomised controlled study. Arch Gerontol Geriatr. 1994;18:15–23. doi: 10.1016/0167-4943(94)90044-2.
    1. Fletcher AE, Price GM, Ng ES, Stirling SL, Bulpitt CJ, Breeze E, Nunes M, Jones DA, Latif A, Fasey NM, Vickers MR, Tulloch AJ. Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial. Lancet. 2004;364:1667–1677. doi: 10.1016/S0140-6736(04)17353-4.
    1. Hebert R, Robichaud L, Roy PM, Bravo G, Voyer L. Efficacy of a nurse-led multidimensional preventive programme for older people at risk of functional decline. A randomized controlled trial. Age Ageing. 2001;30:147–153. doi: 10.1093/ageing/30.2.147.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.
    1. Markle-Reid M, Browne G. Conceptualizations of frailty in relation to older adults. J Adv Nurs. 2003;44:58–68. doi: 10.1046/j.1365-2648.2003.02767.x.
    1. Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health & Social Behavior. 1997;38:21–37. doi: 10.2307/2955359.
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med. 2001;134:657–662.
    1. Oxman AD, Guyatt GH. A consumer's guide to subgroup analyses. Ann Intern Med. 1992;116:78–84.
    1. Pocock SJ, Hughes MD, Lee RJ. Statistical problems in the reporting of clinical trials. A survey of three medical journals. N Engl J Med. 1987;317:426–432.
    1. Stuck A, Kane RL. Whom Do Preventive Home Visits Help? J Am Geriatr Soc. 2007;56:561–563. doi: 10.1111/j.1532-5415.2007.01561.x.
    1. Gill TM, Baker DI, Gottschalk M, Gahbauer EA, Charpentier PA, de Regt PT, Wallace SJ. A prehabilitation program for physically frail community-living older persons. Arch Phys Med Rehabil. 2003;84:394–404. doi: 10.1053/apmr.2003.50020.
    1. Phelan EA, Williams B, Penninx BW, LoGerfo JP, Leveille SG. Activities of daily living function and disability in older adults in a randomized trial of the health enhancement program. J Gerontol A Biol Sci Med Sci. 2004;59:838–843.
    1. Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613–620. doi: 10.1001/jama.281.7.613.
    1. Onder G, Liperoti R, Soldato M, Carpenter I, Steel K, Bernabei R, Landi F. Case management and risk of nursing home admission for older adults in home care: results of the AgeD in HOme Care Study. J Am Geriatr Soc. 2007;55:439–444. doi: 10.1111/j.1532-5415.2007.01079.x.
    1. Luker K. Elderly women's opinions about the benefits of health visitor visits. Nurs Times. 1981;77:33–35.
    1. Gunner Svensson F, Ipsen J, Olsen J, Waldstrom B. Prevention of relocation of the aged in nursing homes. Scand J Prim Health Care. 1984;2:49–56. doi: 10.3109/02813438409017704.
    1. Vetter NJ, Jones DA, Victor CR. Effect of health visitors working with elderly patients in general practice: a randomised controlled trial. Br Med J (Clin Res Ed) 1984;288:369–372.
    1. Hendriksen C, Lund E, Stromgard E. Consequences of assessment and intervention among elderly people: a three year randomised controlled trial. Br Med J (Clin Res Ed) 1984;289:1522–1524.
    1. Sorensen KH, Sivertsen J. Follow-up three years after intervention to relieve unmet medical and social needs of old people. Comprehensive Gerontology Section B, Behavioural, Social & Applied Sciences. 1988;2:85–91.
    1. Carpenter GI, Demopoulos GR. Screening the elderly in the community: controlled trial of dependency surveillance using a questionnaire administered by volunteers. BMJ. 1990;300:1253–1256.
    1. McEwan RT, Davison N, Forster DP, Pearson P, Stirling E. Screening elderly people in primary care: a randomized controlled trial.[comment] British Journal of General Practice. 1990;40:94–97.
    1. Oktay JS, Volland PJ. Post-hospital support program for the frail elderly and their caregivers: a quasi-experimental evaluation. Am J Public Health. 1990;80:39–46.
    1. Clarke M, Clarke SJ, Jagger C. Social intervention and the elderly: a randomized controlled trial. Am J Epidemiol. 1992;136:1517–1523.
    1. Vetter NJ, Lewis PA, Ford D. Can health visitors prevent fractures in elderly people? BMJ. 1992;304:888–890.
    1. Fabacher D, Josephson K, Pietruszka F, Linderborn K, Morley JE, Rubenstein LZ. An in-home preventive assessment program for independent older adults: a randomized controlled trial. J Am Geriatr Soc. 1994;42:630–638.
    1. Wagner EH, LaCroix AZ, Grothaus L, Leveille SG, Hecht JA, Artz K, Odle K, Buchner DM. Preventing disability and falls in older adults: a population-based randomized trial. Am J Public Health. 1994;84:1800–1806.
    1. Archbold PG, Stewart BJ, Miller LL, Harvath TA, Greenlick MR, Van Buren L, Kirschling JM, Valanis BG, Brody KK, Schook JE, et al. The PREP system of nursing interventions: a pilot test with families caring for older members. Preparedness (PR), enrichment (E) and predictability (P) Res Nurs Health. 1995;18:3–16. doi: 10.1002/nur.4770180103.
    1. Stuck AE, Aronow HU, Steiner A, Alessi CA, Bula CJ, Gold MN, Yuhas KE, Nisenbaum R, Rubenstein LZ, Beck JC. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community.[comment] New England Journal of Medicine. 1995;333:1184–1189. doi: 10.1056/NEJM199511023331805.
    1. Hebert R, Robichaud L, Roy PM, Bravo G, Voyer L. Efficacy of a nurse-led multidimensional preventive programme for older people at risk of functional decline. A randomized controlled trial. Age Ageing. 2001;30:147–153. doi: 10.1093/ageing/30.2.147.
    1. Newbury JW, Marley JE, Beilby JJ. A randomised controlled trial of the outcome of health assessment of people aged 75 years and over. Medical Journal of Australia. 2001;175:104–107.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa