BMJ 2001;323:719 ( 29 September )

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

Ruth Elkan, research fellow, ^a Denise Kendrick, senior lecturer, ^b Michael Dewey, senior lecturer, ^c Michael Hewitt, evaluation and effectiveness manager, ^d Jane Robinson, professor emeritus, ^a Mitch Blair, senior lecturer in child health, ^e Deb Williams, lecturer, ^a Kathy Brummell, health visitor. ^a

^a School of Nursing, Postgraduate Division, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, ^b School of Community Health Sciences, Division of General Practice, Floor 13, Tower Building, University Park, Nottingham NG7 2RD, ^c School of Community Health Sciences, Trent Institute for Health Services Research, University of Nottingham, Queen's Medical Centre, Nottingham, ^d Evaluation Audit Centre for Research, Kingsmill Centre, Sutton in Ashfield, Nottinghamshire NG17 4JL, ^e Northwick Park and St Mark's NHS Trust, Harrow, Middlesex HA1 3UJ

Correspondence to: R Elkan Ruth.Elkan{at}nottingham.ac.uk

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.

What is already known on this topic The benefits of regular, preventive home visits to older people are the subject of controversy A recent systematic review found no clear evidence that preventive home visits were effective What this study adds This meta-analysis of 15 trials shows that home visiting can reduce mortality and admission to institutional care among older people

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