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

<h4>Background</h4>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.<h...

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Autores principales:	Evan Mayo-Wilson, Sean Grant, Jennifer Burton, Amanda Parsons, Kristen Underhill, Paul Montgomery
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/25dddbb656ca47c6a4dc8adf809867f5
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spelling	oai:doaj.org-article:25dddbb656ca47c6a4dc8adf809867f52021-11-18T08:28:23ZPreventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.1932-620310.1371/journal.pone.0089257https://doaj.org/article/25dddbb656ca47c6a4dc8adf809867f52014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24622676/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods and findings</h4><h4>Data sources</h4>Ten databases including CENTRAL and Medline searched through December 2012.<h4>Study selection</h4>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.<h4>Data extraction and synthesis</h4>Two authors independently extracted data. Outcomes were pooled using random effects.<h4>Main outcomes and measures</h4>Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.<h4>Results</h4>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 -0.03]) respectively, but these may not be clinically important.<h4>Conclusions</h4>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.Evan Mayo-WilsonSean GrantJennifer BurtonAmanda ParsonsKristen UnderhillPaul MontgomeryPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e89257 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Evan Mayo-Wilson Sean Grant Jennifer Burton Amanda Parsons Kristen Underhill Paul Montgomery Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.
description	<h4>Background</h4>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.<h4>Methods and findings</h4><h4>Data sources</h4>Ten databases including CENTRAL and Medline searched through December 2012.<h4>Study selection</h4>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.<h4>Data extraction and synthesis</h4>Two authors independently extracted data. Outcomes were pooled using random effects.<h4>Main outcomes and measures</h4>Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.<h4>Results</h4>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 -0.03]) respectively, but these may not be clinically important.<h4>Conclusions</h4>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.
format	article
author	Evan Mayo-Wilson Sean Grant Jennifer Burton Amanda Parsons Kristen Underhill Paul Montgomery
author_facet	Evan Mayo-Wilson Sean Grant Jennifer Burton Amanda Parsons Kristen Underhill Paul Montgomery
author_sort	Evan Mayo-Wilson
title	Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.
title_short	Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.
title_full	Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.
title_fullStr	Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.
title_full_unstemmed	Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.
title_sort	preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/25dddbb656ca47c6a4dc8adf809867f5
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Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.

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