What is the effectiveness of home visiting or home-based support for older people?

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Summary

The issue

The vast majority of older people wish to remain living in their own homes. Furthermore, institutional care is costly. Consequently there are social and economic imperatives to prevent ill health and disability in older people and enable them to remain in their own homes as long as possible. Home visiting and home-based support are interventions that may be used to these ends.

Previous reviews of the effectiveness of home visiting programmes for older people appear to have produced inconsistent and conflicting results. This synthesis has critically appraised all reviews related to home visiting to determine consistent findings.

Findings

There is consistent evidence that home visits could reduce mortality and nursing home admissions. There is some evidence that the reduction in mortality may be greater among the younger elderly, and that nursing home admissions may be reduced to a greater extent with a greater number of visits. Home visiting has not been shown to reduce functional decline, except amongst those with a low mortality rate and in programmes providing multidimensional geriatric assessment and follow up. Home visiting programmes have the potential to be cost-effective due to their low cost compared to long-term institutional care.

Policy considerations

Evidence shows that home visits can reduce mortality and nursing home admissions in some groups of older people. Characteristics of effective home-visiting programmes include multidimensional assessment, many follow-up visits and targeting people at lower risk of death.

Further research is required to determine:

  • which aspects of multifaceted interventions are responsible for beneficial effects;
  • the effectiveness of different professionals and volunteers;
  • the optimal number and duration of home visits;
  • which groups of older people are most likely to benefit from home visits;
  • the costs and benefits of a programme within the local health care system;
  • the effectiveness of home visiting programmes among less affluent populations.

This review does not provide evidence for stopping existing home-visiting programmes, but further research is required to answer the questions outlined above prior to implementing new programmes.