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Do Structured Home Visits Prevent Functional Decline?
Am Fam Physician. 2005 Nov 15;72(10):2112-2113.
It is unclear from existing controlled trials whether preventive home visits to older, community-dwelling persons are beneficial. Content, number of visits, visit intervals, and age group to target have not been established. Vass and colleagues conducted a study to determine whether training physicians to use a preventive home-visit assessment tool could improve active life expectancy among older adults. Outcome measures included functional ability, nursing home admissions, and mortality rates.
The study was performed in 34 Danish municipalities. Professionals in the 17 intervention municipalities received training in preventive home visits using a standard geriatric assessment tool. They were advised to evaluate functional ability at every visit, and to refer persons with signs of physical, social, or mental problems for further assessment by the family physician. Family physicians were encouraged to evaluate the patients for delirium, depression, dementia, drugs, and drink (the five Ds). The control group consisted of the 17 other municipalities, in which physicians conducted home visits according to their own protocols.
A total of 2,529 participants 75 years of age and 957 participants 80 years of age completed the three-year follow-up. Functional ability was assessed at baseline and at follow-up using a dichotomized variable: the ability or inability to manage all activities independently. The intervention group was associated with improved functional ability in the 80-year-old participants but not in the 75-year-old participants. Overall, the odds ratio for functional improvement in the intervention group compared with the control was 1.20 (95% confidence interval, 1.01 to 1.42). There were trends toward decreased nursing home admissions in the intervention group but no statistically significant reduction in nursing home admissions or mortality. A dose-response curve was evident in the 80-year-old cohort: the greater and more regular the number of visits, the greater the participants’ functional ability.
The authors concluded that, in the context of a wealthy welfare state with a home visit program in place, preventive home visits from trained physicians were of benefit to persons 80 years of age. They suggest that proactive prevention programs can prevent functional decline and possibly reduce nursing home admissions, but that such visits should not occur too early, because benefit was greater in 80-year-old persons, and visits would be limited in effectiveness once patients reached a “point of no return” in functional decline.
Vass M, et al. Feasible model for prevention of functional decline in older people: municipality-randomized, controlled trial. J Am Geriatr Soc. April 2005;53:563-8.
Copyright © 2005 by the American Academy of Family Physicians.
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