Preventive home visits for mortality, morbidity, and institutionalization in older adults: A systematic review and meta-analysis

Evan R Mayo-Wilson, Sean Grant, Jennifer Burton, Amanda Parsons, Kristen Underhill, Paul Montgomery

Research output: Contribution to journalArticle

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. Methods and Findings: Data Sources: Ten databases including CENTRAL and Medline searched through December 2012. Study Selection: 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. Data Extraction and Synthesis: Two authors independently extracted data. Outcomes were pooled using random effects. Main Outcomes and Measures: 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 20.03]) 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.

Original languageEnglish (US)
Article numbere89257
JournalPLoS One
Volume9
Issue number3
DOIs
StatePublished - Mar 12 2014
Externally publishedYes

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Institutionalization
House Calls
systematic review
Independent Living
meta-analysis
morbidity
Meta-Analysis
Morbidity
Mortality
Surface mount technology
quality of life
Quality of Life
Health
Medication Adherence
dementia
Information Storage and Retrieval
relative risk
odds ratio
Psychiatry
Dementia

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Preventive home visits for mortality, morbidity, and institutionalization in older adults : A systematic review and meta-analysis. / Mayo-Wilson, Evan R; Grant, Sean; Burton, Jennifer; Parsons, Amanda; Underhill, Kristen; Montgomery, Paul.

In: PLoS One, Vol. 9, No. 3, e89257, 12.03.2014.

Research output: Contribution to journalArticle

Mayo-Wilson, Evan R ; Grant, Sean ; Burton, Jennifer ; Parsons, Amanda ; Underhill, Kristen ; Montgomery, Paul. / Preventive home visits for mortality, morbidity, and institutionalization in older adults : A systematic review and meta-analysis. In: PLoS One. 2014 ; Vol. 9, No. 3.
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