Effectiveness of home based support for older people: systematic review and meta-analysis.

OBJECTIVE To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. DESIGN Systematic review and meta-analysis of 15 studies of home visiting. PARTICIPANTS older people living at home, including frail older people at risk of adverse outcomes. OUTCOME MEASURES Mortality, admission to hospital, admission to institutional care, functional status, health status. RESULTS Home visiting was associated with a significant reduction in mortality. The pooled odds ratio for eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term institutional care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, "at risk" older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardised effect size 0.06; -0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; -0.07 to 0.17). CONCLUSION Home visits to older people can reduce mortality and admission to long term institutional care.