A systematic review 1 including 21 studies with a total of 14 597 older adults (mean age>70 years) was abstracted in DARE. The included multidimensional preventive home visit programs were required to have a broad focus and regular follow-up contact with participants such as multiple home visits. The median number of home visits was 4.3. The interventions were delivered by e.g. community nurse, health visitor, geriatric nurse, geriatrician or volunteer. Most of the studies had a usual care comparator. Intervention duration ranged from 4 months to 4 years. There was a modest and not statistically significant reduction in the risk of nursing home admission (OR 0.86, 95% CI 0.68 to 1.10) and little non-significant effect on functional status (OR 0.89, 95% CI 0.76 to 1.03; 16 trials) or mortality (OR 0.92, 95% CI 0.80 to 1.05; 21 trials). Studies that included a clinical examination showed a beneficial effect on functional status (OR 0.64, 95% CI 0.48 to 0.87) but the other studies did not. Trials with the youngest mean age group showed a beneficial effect of the intervention on mortality (OR 0.74, 95% CI 0.58 to 0.94) compared to the trials of the oldest participants.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and in results in different populations).
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