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‘We are not saying that those people currently getting home care visits should have this service withdrawn,” said Sean Grant, from Oxford University’s Centre for Evidence-Based Intervention.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.
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The quality of home care- i.e. skills, expertise and professional training of staff as well as frequency of visits to clients in need are issues which will impact on outcomes for those receiving it. The issue is complex .
In the UK anyone off the street can become a care worker, with a few days induction by a care agency whose manager owner with no experience in the field of care being not unusual. I have no doubt this contributes to the findings from this research.
Also independence is not the same for the very elderly living at home, it is about staying living in the place they consider home rather than with strangers- for many this outcome is uppermost, not what commissioning organisations seek as outcomes.
Whether quality of life is better in ones own home or a residential establishment is a lottery entirely dependent on the quality, motivation and skills of the care staff. Unfortunately this field is littered with people who need employment not who actually want these low paid and emotionally and physically demanding jobs. I have dealt with over 100 of them and barely half a dozen would be worth having. Most have no choice having entered as immigrants with other skills which they are unable to use here.
But I have seen that some nursing homes actually employ overseas trained nurses who have not managed to get registration as nurses, they get paid as care workers, one might see quality / understanding more often of elderly with health issues from these skilled recruits. Of course this is not a general picture of residential care in this country, but it can make a difference to ‘safety’ and well being..
Thank goodness you say about choice. Many older people choose to remain in their own homes for as long as they can and families want to support their elders to do that.
What is happening when a piece of research can conclude no benefit when overlooking a fundamental factor – customer choice and feeling of well being! And an element of control over their own life.
Others may choose alternatives and that’s a choice too.
The criteria of successful outcomes in this study seem mostly to be health based.
“Quality of life” seems to be a criteria but it is not clear how they measured that. Home care might not remove the risks of falls or illness or hospital admission but surely a significant issue is whether the person would rather stay at home and what would enable them to stay at home as long as possible?
If the research, which seems to be significant research ie over 20 years and with randomised controls, is saying that homecare does not keep people at home longer then that is a significant finding that has far reaching policy implications.
An interesting study,however,I would suggest flawed in its outcome. How many elderly people would have died or had mental issues, or just faded away without home care. Measured criteria parameters must be kept the same if any value is to be achieved from reports like these.
This study is NOT about home care (i.e. personal care). It is about ‘preventive home VISITS’ by health and social care professionals. The studies they looked at included falls prevention, assessments and exercise, for example. Its says:
‘Preventive home visits by health professionals aim to increase autonomy through primary, secondary, and tertiary prevention activities. These differ from home care interventions to treat or to rehabilitate people with medical problems. Some programs focus on one risk factor, such as falls. Others include multidimensional geriatric assessment (MGA) to evaluate and to improve medical, functional, psychosocial, and environmental problems and resources. Whilst proximal outcomes differ, these interventions all ultimately aim to prevent negative long-term outcomes like institutionalization and mortality.’
That’s a good job, really, because it would be completely unethical to withhold home care from people who need it for the reasons Philip says – people would simply fade away and die. Randomised control trials are not something that should be used to generate evidence for services like home care, and the research/funding world needs to understand that.
Also, as G Hall says, ‘quality of life’ is a bit of unscientific measure and doesn’t seem to fit with RCTs. Maybe more researchers should use comparable tools such as the Adult Social Care Outcomes Toolkit which measures social care related quality of life in a number of areas of one’s life.
4 thoughts:
1…. Who commissioned this survey?
2…. For what purpose was the survey commissioned?
3…. How do you measure ‘benefit’ in a person centred, individualised package of care?
4…. Were service users asked if their home care package was of ‘benefit’?
The research is NOT about home care (i.e. personal care) at all. It is about home visits by health and social care professionals with the purposes of, for example, falls prevention, assessment and exercise.
The report says: ‘Preventive home visits by health professionals aim to increase autonomy through primary, secondary, and tertiary prevention activities. These differ from home care interventions to treat or to rehabilitate people with medical problems.’
It would be completely unethical to withhold home care from people anyway, so RCTs would be unsuitable to evaluate its impact. As Philip points out, people in the control group might simply fade away and die.
This article is not helpful for the reputation or funding of home care as it misrepresents what the research report says.
Hi Katharine
Thanks very much and you’re absolutely right.
The article wrongly referred to home care. Many apologies for the error.
I’ve now updated it with the correct information.
Thanks very much for the comments.
Mithran
Thank you, Mithran. You might like to consider putting out an ‘erratum’ notification in another daily bulletin as those who receive the one with the orginal title will be under the impression that home care is worthless.
Katharine
Thanks Katharine.
The corrected story went in our biggest bulletin – the weekly bulletin on Wednesday – and we will also include it in tomorrow’s daily bulletin.
Mithran
Do Community Care plan to do a more in-depth story on this with some critique/commentary?
Sorry, but this article reads like a press release to me.
As previous posts put it far more succinctly, more questions need asking of this research, as surely the outcome has far-reaching implications for social care if it is as it says on the tin. If…
P.S – thought we’d moved on from describing older people as “the elderly”, who from the above article, appear not to need to consider the outcomes of this research as much as the policy makers, professionals and families, when making decisions about their own, personalised support…