Article corrected 18 March 9pm
There is no consistent or robust evidence for the benefits of preventative home visits to help improve the independence of older people, a review of research conducted over the past 20 years has concluded.
There is no evidence to demonstrate older people who receive such visits live longer or lead more independent lives than those who do not receive the visits, found an Oxford University and University College London analysis of 64 randomised controlled trials, mainly in the UK, United States and Canada.
The trials studied involved over 29,000 people aged over 65 who were living independently, and researchers analysed their findings about the impact of home visits on mortality rates, falls, the risks of injury and illness, rates of hospitalisation or institutionalisation, and the overall quality of life.
The research defined home visits as interventions by health or social care professionals to boost the independence of older people, including through the provision of information, assessment, referral to other services or efforts to increase medication compliance.
It stressed that the study did not cover home care services to “treat or rehabilitate people with medical problems”.
‘We are not saying that those people currently getting home care visits should have this service withdrawn,” said Sean Grant, from Oxford University’s Centre for Evidence-Based Intervention. “This review is pointing out that despite home care visits being available to [older people] in many countries, there is no robust, consistent evidence to show they provide any benefit to [older people] that we can measure. It is possible that some programmes may provide some benefit. In the light of this review, however, policy-makers, professionals and families should carefully consider the alternatives when making decisions about effective means of support for [older people] in the community.’
The review examined trials that focused solely on home visits and those where home visits were part of a wider programme of services.
Researchers found that the quality of evidence from the trials was “variable” and many provided limited information on what might have worked and what did not work within services.
The review recommended that any future trials needed to provide more detailed information, such as why older people needed home visits, how many home visits they actually received, and the characteristics of older recipients of home visits and the professionals delivering the service.
About the research
The research team identified 64 relevant studies, carried out from 1981 to 2012 in 13 countries, and involving 28,642 older people. Eleven of the studies were in the UK.
The average number of home visits per study was 4.9. In 27 studies, visits were made by nurses alone, and in 20 cases, they were made by other professionals, such as occupational therapists or social workers. In 17 of the studies the objective of the visits was falls prevention, while in 25 it was a comprehensive assessment of the person.
In 50 of the 64, the control group who did not receive home visits received their “usual care” services, and there was low risk of bias in most (41) of the studies.
Twenty six of the studies reported outcomes about the number of participants admitted to institutional care, and researchers found “moderate quality evidence of no clinically important difference” between people who received the visits and those who did not.
Fifteen reported the numbers of people admitted to hospital for which there was “moderate quality evidence of a small relative effect that may not be clinically important” from receiving home visits.
Twenty three studies recorded the number of people who fell for which there was “moderate quality evidence of a small effect…but it was not statistically significant”.
The study was published in the journal PLOS ONE.
- This article was updated on 18 March to correct errors in the original, which wrongly stated that the study related to home care services, rather than preventative home visits.