Effectiveness of home based support for older people: systematic review and meta-analysis

Abstract

Objective: To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people.

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

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

Outcome measures: 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).

Conclusion: Home visits to older people can reduce mortality and admission to long term institutional care.

Figures

Figure 1

Log odds ratios and 95% confidence intervals for mortality in general elderly population (test for homogeneity: Q=6.91, df=7, P=0.44) and frail elderly population (Q=0.87, df=3, P=0.83)

Figure 2

Log odds ratios and 95% confidence intervals for hospital admissions in general elderly population (test for homogeneity: Q=1.42, df=3, P=0.04)

Figure 3

Effect sizes and 95% confidence intervals for health status (test for homogeneity: Q=2.89, df=2, P=0.24)

Figure 4

Effect sizes and 95% confidence intervals for functional ability (test for homogeneity: Q=3.67, df=3, P=0.30)

Figure 5

Log odds ratios and 95% confidence intervals for institutional care in general elderly population (test for homogeneity: Q=3.19, df=3, P=0.36) and frail elderly population (Q=2.64, df=2, P=0.27)

Figure

Meta-analysis of eight trials of effect of preventive home visits on admission to long term institutional care. Data taken from table 4. Elkan et al's classification of study population (general elderly population or frail elderly) and mortality in control groups are also shown