Effectiveness of home based support for older people: systematic review and meta-analysis Commentary: When, where, and why do preventive home visits

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.

The trade-off between formal and informal care in Spain

“…Two factors may explain why husbands of disabled women play a much lesser role than wives of disabled men. First, husbands of disabled women may be less able to provide care because they may be older 22 and more disabled than wives of disabled men. Second, husbands may be less prepared to fulfill the social role of caregiver without the presence of disability (Lee et al, 1993).…”

“…Although we could think that gender differences related to IADL disabilities are connected to houseworking, support for grocery and 22 In 2006, average marriage was 33.8 for men and 30.8 for women (27.4 and 24.5, respectively in 1975).…”

Assessing Safe and Independent Living in Vulnerable Older Adults: Perspectives of Professionals Who Conduct Home Assessments

“…12,13 The issue of assessing vulnerability, therefore, is of particular importance to primary care physicians. However, the clues to recognizing vulnerability are often not readily apparent during routine primary care visits.…”

Multi-component health promotion and disease prevention for community-dwelling frail elderly persons: a systematic review

“…Several reports suggest that there is no single approach that effectively addresses functional problems. Similar to other geriatric syndromes, a multi-component approach may more effectively address functional difficulties (Elkan et al 2001;Stuck et al 2002;Ferrucci et al 2004). Consequently, a multi-component health-promoting and disease-preventive intervention programme (HPDP programme) could avert and delay dependence in ADL and the development of functional decline.…”

“…There are some reviews concerning HPDP interventions for elderly persons Elkan et al 2001;Stuck et al 2002;Bouman et al 2008c;Huss et al 2008), but none of them focuses on frail elderly persons. In addition, the concept of frailty has been studied and reviewed earlier (Hogan et al 2003) but without focusing on the clinical perspective where frailty is operationalised in HPDP programmes.…”