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

Objective To evaluate the effectiveness of home visiting programmes that of fer 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 r isk of adverse outcomes. Outcome measures Mortality, admission to hospital, admission to institution al care, functional status, health status. Results Home visiting was associated with a significant reduction in mortal ity. The pooled odds ratio for eight studies that assessed mortality in mem bers 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 a t 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 redu ction in admissions to long term institutional care in members of the gener al elderly population (0.65; 0.46 to 0.91). For three studies of home visit ing 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 g eneral elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significa nt effect on health (standardised effect size 0.06; -0.07 to 0.18). Four st udies 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 t o long term institutional care.