Multidimensional preventive home visit programs for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials

被引：205

作者：

Huss, Anke ^{[2
,3
]}

Stuck, Andreas E. ^{[1
,2
]}

Rubenstein, Laurence Z. ^{[4
,5
]}

Egger, Matthias ^{[3
,6
]}

Clough-Gorr, Kerri M. ^{[1
,2
]}

机构：

[1] Spital Netz Bern Ziegler, Univ Dept Geriatr, CH-3001 Bern, Switzerland

[2] Inselspital Univ Bern Hosp, Dept Geriatr, Bern, Switzerland

[3] Univ Bern, Inst Social & Prevent Med, CH-3012 Bern, Switzerland

[4] Univ Calif Los Angeles, VA Med Ctr, Geriatr Res Educ, Sepulveda, CA USA

[5] Univ Calif Los Angeles, VA Med Ctr, Ctr Clin, Sepulveda, CA USA

[6] Univ Bristol, Dept Social Med, Bristol BS8 1TH, Avon, England

来源：

JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES | 2008年 / 63卷 / 03期

关键词：

aged; geriatric assessment; home visit; in-home; multidimensional geriatric assessment; older adults; preventive home visit;

D O I：

10.1093/gerona/63.3.298

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

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.

引用

页码：298 / 307

页数：10