Home visits for prevention of impairment and death in older adults

Additional Info

  • Authors: Sean Grant, Amanda Parsons, Jennifer Burton, Paul Montgomery, Kristen Underhill, Evan Mayo-Wilson
  • Published date: 2014-05-01
  • Coordinating group(s): Social Welfare
  • Type of document: Title, Protocol, Review, Plain language summary, Data
  • Volume: 10
  • Issue nr: 3
  • Category Image: Category Image
  • PLS Title: Home visits appear not to be effective, but better evidence may show some benefits for some groups from some interventions
  • PLS Description: This review examines the effectiveness of home visits in reducing impairment, institutionalization, and death in older adults. Factors that may moderate effects are identified.
  • Title: Home visits for prevention of impairment and death in older adults
  • Spanish PLS: Las visitas a domicilio parecen no ser eficaces, pero mejor evidencia podría mostrar algunos beneficios para ciertos grupos sociales a partir de intervenciones específicas
  • Spanish PLS Description: Las visitas a domicilio por parte de asistentes sociales y profesionales de la salud son una intervención de tipo preventivo que apunta principalmente a los adultos mayores. Su principal objetivo es mantener saludables y autónomos a los residentes de la comunidad que conforman dicho grupo etario. Este tipo de intervención preventiva considera estrategias para disminuir una serie de factores de riesgo que los adultos mayores deben afrontar con respecto a la morbilidad y a la mortalidad relacionados con dificultades físicas, funcionales, psicológicas, medioambientales y sociales. La presente revisión analiza la eficacia de las visitas a domicilio en la reducción de la discapacidad, de la necesidad de internación y de la tasa de fallecimiento entre adultos mayores. Se identifican además aquellos factores que pudieran atenuar los efectos esperados.
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About this systematic review

This Campbell systematic review assesses the effectiveness of home visits in preventing impairment, institutionalization, and death in older adults, as well as identifying factors that may moderate effects. The review summarises findings from 64 studies.

What are the main results?

Overall, home visits are not effective in maintaining the health and autonomy of community-dwelling older adults. Preventive home visits did not reduce absolute mortality, and did not have a significant overall effect on the number of people who were institutionalised.

There is high-quality evidence of no effect on falls from interventions targeting fall prevention. There is low-quality evidence of small statistically significant positive effects for functioning and quality of life.

It is possible that some programmes have modest effects on institutionalisation and hospitalisation. However, heterogeneity in target population and intervention design, as well as poor reporting of in studies of design, implementation and the control condition make this difficult to determine.


Home visits by health and social care professionals aim to prevent cognitive and functional impairment, thus reducing institutionalisation and prolonging life. Visitors may provide health information, investigate untreated or sub-optimally treated problems, encourage compliance with medical care, and provide referrals to services. Previous reviews have reached varying conclusions about their effectiveness. This review sought to assess the effectiveness of preventive home visits for older adults (65+ years) and to identify factors that may moderate effects.


To systematically review evidence on the effectiveness of preventive home visits for older adults, and to identify factors that may moderate effects.

Search strategy

We searched the following electronic databases through December 2012 without language restrictions: British Nursing Index and Archive, C2-SPECTR, CINAHL, CENTRAL, EMBASE, IBSS, Medline, Nursing Full Text Plus, PsycINFO, and Sociological Abstracts. Reference lists from previous reviews and from included studies were also examined.

Selection criteria

We included randomised controlled trials enrolling persons without dementia aged over 65 years and living at home. Interventions included visits at home by a health or social care professional that were not directly related to recent hospital discharge. Interventions were compared to usual care, wait-list, or attention controls.

Data collection and analysis

Two authors independently extracted data from included studies in pre-specified domains, assessed risk of bias using the Cochrane Risk of Bias tool, and rated the quality of evidence using GRADE criteria. Outcomes were pooled using random effects models. We analyzed effects on mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.


Sixty-four studies with 28642 participants were included. There was high quality evidence that home visits did not reduce absolute mortality at longest follow-up (Risk ratio=0.93 [0.87 to 0.99]; Risk difference=0.00 [-0.01 to 0.00]). There was moderate quality evidence of no clinically or statistically significant overall effect on the number of people who were institutionalised (Risk ratio=1.02 [0.88, 1.18]) or hospitalised (Risk ratio=0.96 [0.91, 1.01]) during the studies. There was high quality evidence of no statistically significant effect on the number of people who fell (Odds ratio=0.86 [0.73, 1.01]). There was low quality evidence of statistically significant effects for quality of life (Standardised mean difference=-0.06 [-0.11, -0.01]) and very low quality evidence of statistically significant effects for functioning (SMD=-0.10 [-0.17, -0.03]), but these overall effects may not be clinically significant. However, there was heterogeneity in settings, types of visitor, focus of visits, and control groups. We cannot exclude the possibility that some programmes were associated with meaningful benefits.

Authors’ conclusions

We were unable to identify reliable effects of home visits overall or in any subset of the studies in this review. It is possible that some home visiting programmes have beneficial effects for community-dwelling older adults, but poor reporting of how interventions and comparisons were implemented prevents more robust conclusions. While it is difficult to draw firm conclusions given these limitations, estimates of treatment effects are statistically precise, and further small studies of multi-component interventions compared with usual care would be unlikely to change the conclusions of this review. If researchers continue to evaluate these types of interventions, they should begin with a clear theory of change, clearly describe the programme theory of change and implementation, and report all outcomes measured.

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