HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Huss, A. Articles by Clough-Gorr, K. M. Search for Related Content PubMed PubMed Citation Articles by Huss, A. Articles by Clough-Gorr, K. M.

Multidimensional Geriatric Assessment: Back to the Future Multidimensional Preventive Home Visit Programs for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

¹ Department of Geriatrics, Inselspital University of Bern Hospital, Switzerland.
² Institute of Social and Preventive Medicine, University of Bern, Switzerland.
³ University Department of Geriatrics, Spital Netz Bern Ziegler, Switzerland.
⁴ Geriatric Research Education and Clinical Center, UCLA-VA Medical Center, Sepulveda, California.
⁵ Department of Social Medicine, University of Bristol, United Kingdom.

Address correspondence to Andreas E. Stuck, MD, University Department of Geriatrics, Spital Netz Bern Ziegler, Morillonstrasse 75-91, CH-3001 Bern, Switzerland. E-mail: andreas.stuck{at}spitalnetzbern.ch

Background. Multidimensional preventive home visit programs aim at maintaining health and autonomy of older adults and preventing disability and subsequent nursing home admission, but results of randomized controlled trials (RCTs) have been inconsistent. Our objective was to systematically review RCTs examining the effect of home visit programs on mortality, nursing home admissions, and functional status decline.

Methods. Data sources were MEDLINE, EMBASE, Cochrane CENTRAL database, and references. Studies were reviewed to identify RCTs that compared outcome data of older participants in preventive home visit programs with control group outcome data. Publications reporting 21 trials were included. Data on study population, intervention characteristics, outcomes, and trial quality were double-extracted. We conducted random effects meta-analyses.

Results. Pooled effects estimates revealed statistically nonsignificant favorable, and heterogeneous effects on mortality (odds ratio [OR] 0.92, 95% confidence interval [CI], 0.80–1.05), functional status decline (OR 0.89, 95% CI, 0.77–1.03), and nursing home admission (OR 0.86, 95% CI, 0.68–1.10). A beneficial effect on mortality was seen in younger study populations (OR 0.74, 95% CI, 0.58–0.94) but not in older populations (OR 1.14, 95% CI, 0.90–1.43). Functional decline was reduced in programs including a clinical examination in the initial assessment (OR 0.64, 95% CI, 0.48–0.87) but not in other trials (OR 1.00, 95% CI, 0.88–1.14). There was no single factor explaining the heterogenous effects of trials on nursing home admissions.

Conclusion. Multidimensional preventive home visits have the potential to reduce disability burden among older adults when based on multidimensional assessment with clinical examination. Effects on nursing home admissions are heterogeneous and likely depend on multiple factors including population factors, program characteristics, and health care setting.

Key Words: Aged • Geriatric assessment • Home visit • In-home • Multidimensional geriatric assessment • Older adults • Preventive home visit