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Dagens #fsvoversigt:
Preventive home visits for mortality, morbidity, and institutionalization in
older adults: a systematic review and meta-analysis.
PLoS One. 2014;9(3):e89257
Authors: Mayo-Wilson E, Grant S, Burton J, Parsons A, Underhill K, Montgomery P
Abstract
BACKGROUND: Home visits for older adults aim to prevent cognitive and
functional impairment, thus reducing institutionalization and mortality.
Visitors may provide information, investigate untreated problems, encourage
medication compliance, and provide referrals to services.
METHODS AND FINDINGS:
DATA SOURCES: Ten databases including CENTRAL and Medline searched through
December 2012.
STUDY SELECTION: Randomized controlled trials enrolling community-dwelling
persons without dementia aged over 65 years. Interventions included visits at
home by a health or social care professional that were not related to hospital
discharge.
DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data.
Outcomes were pooled using random effects.
MAIN OUTCOMES AND MEASURES: Mortality, institutionalization, hospitalization,
falls, injuries, physical functioning, cognitive functioning, quality of life,
and psychiatric illness.
RESULTS: Sixty-four studies with 28642 participants were included. Home visits
were not associated with absolute reductions in mortality at longest follow-up,
but some programs may have small relative effects (relative risk = 0.93 [0.87
to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]). There was moderate quality
evidence of no overall effect on the number of people institutionalized (RR =
1.02 [0.88 to 1.18]) or hospitalized (RR = 0.96 [0.91 to 1.01]). There was high
quality evidence for number of people who fell, which is consistent with no
effect or a small effect (odds ratio = 0.86 [0.73 to 1.01]), but there was no
evidence that these interventions increased independent living. There was low
and very low quality evidence of effects for quality of life (standardised mean
difference = -0.06 [-0.11 to -0.01]) and physical functioning (SMD = -0.10
[-0.17 to -0.03]) respectively, but these may not be clinically important.
CONCLUSIONS: Home visiting is not consistently associated with differences in
mortality or independent living, and investigations of heterogeneity did not
identify any programs that are associated with consistent benefits. Due to poor
reporting of intervention components and delivery, we cannot exclude the
possibility that some programs may be effective.
PMID: 24622676 [PubMed - indexed for MEDLINE]
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Dette abstract er hentet via PubMed fra National Library of Medicine, USA
(http://www.ncbi.nlm.nih.gov/About/disclaimer.html).
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Se abstractet i PubMed: http://evidens.link/1Mkf6Y3
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