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 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., (C) British Medical Journal 2001.