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Home Visits Provide Little Improvement in Older Patients
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Am Fam Physician. 2008 Oct 1;78(7):874-876.
Background: Studies are inconsistent about the usefulness of home health visits for older persons. An earlier trial showed that preventive home visits had no effect on older persons, although a subgroup analysis suggested that those with self-perceived poor health might benefit. Bouman and colleagues studied the effect of home visits on health outcomes for older patients in poor health.
The Study: A questionnaire was mailed to 5,000 persons 70 to 84 years of age living at home. After screening, 330 persons were eligible for the study. Participants were randomized to receive home-visit interventions (n = 160) or usual care (n = 170). The program involved eight home visits over 18 months by a home health nurse under supervision of a public health nurse. Visits took place every two months with consistent telephone follow-up to ensure adherence. The nurses conducted a thorough assessment of health problems and risks using a questionnaire and checklists. On the basis of the assessment, appropriate advice was given, referrals were made as needed, and each patient's primary care physician was notified. Outcome measures were self-rated health, functional status, activities of daily living (ADL) instrumental activities of daily living (IADL), mental health and social functioning, and changes in health. Patients were assessed with a baseline questionnaire and at 12, 18, and 24 months.
Results: The mean age of the patients was 75.7 years, and about one half of participants had at least one ADL or two IADL dependencies, or both. There was a high rate of self-reported health deterioration in the three months before the screening. Primary outcome data were available for 87 percent of the intervention group and 91 percent of the usual care group. Mortality rates were similar between the two groups. At 12 months, there were no statistically significant differences between groups in self-rated health, ADL, and health change, though a trend slightly favored the intervention group. There were no statistically significant differences in the other outcomes.
Conclusion: The home visits with telephone follow-up did not change patient outcomes. These results indicate that older patients in poor health are unlikely to benefit from a home-visiting program.
Bouman A, et al. Effects of a home visiting program for older people with poor health status: a randomized, clinical trial in the Netherlands. J Am Geriatr Soc. March 2008;56(3):397–404.
Copyright © 2008 by the American Academy of Family Physicians.
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