Huss Anke, Stuck Andreas E, Rubenstein Laurence Z, Egger Matthias, Clough-Gorr Kerri M
Department of Geriatrics, Inselspital University of Bern Hospital, Bern, Switzerland.
J Gerontol A Biol Sci Med Sci. 2008 Mar;63(3):298-307. doi: 10.1093/gerona/63.3.298.
Multidimensional preventive home visit programs aim at maintaining health and autonomy of older adults and preventing disability and subsequent nursing home admission, but results of randomized controlled trials (RCTs) have been inconsistent. Our objective was to systematically review RCTs examining the effect of home visit programs on mortality, nursing home admissions, and functional status decline.
Data sources were MEDLINE, EMBASE, Cochrane CENTRAL database, and references. Studies were reviewed to identify RCTs that compared outcome data of older participants in preventive home visit programs with control group outcome data. Publications reporting 21 trials were included. Data on study population, intervention characteristics, outcomes, and trial quality were double-extracted. We conducted random effects meta-analyses.
Pooled effects estimates revealed statistically nonsignificant favorable, and heterogeneous effects on mortality (odds ratio [OR] 0.92, 95% confidence interval [CI], 0.80-1.05), functional status decline (OR 0.89, 95% CI, 0.77-1.03), and nursing home admission (OR 0.86, 95% CI, 0.68-1.10). A beneficial effect on mortality was seen in younger study populations (OR 0.74, 95% CI, 0.58-0.94) but not in older populations (OR 1.14, 95% CI, 0.90-1.43). Functional decline was reduced in programs including a clinical examination in the initial assessment (OR 0.64, 95% CI, 0.48-0.87) but not in other trials (OR 1.00, 95% CI, 0.88-1.14). There was no single factor explaining the heterogenous effects of trials on nursing home admissions.
Multidimensional preventive home visits have the potential to reduce disability burden among older adults when based on multidimensional assessment with clinical examination. Effects on nursing home admissions are heterogeneous and likely depend on multiple factors including population factors, program characteristics, and health care setting.
多维预防性家访计划旨在维持老年人的健康和自主性，预防残疾及随后的养老院入住，但随机对照试验（RCT）的结果并不一致。我们的目的是系统评价RCT，以检验家访计划对死亡率、养老院入住率和功能状态下降的影响。
数据来源为MEDLINE、EMBASE、Cochrane CENTRAL数据库及参考文献。对研究进行审查，以确定将预防性家访计划中老年参与者的结局数据与对照组结局数据进行比较的RCT。纳入报告21项试验的出版物。对研究人群、干预特征、结局和试验质量的数据进行双人提取。我们进行了随机效应荟萃分析。
汇总效应估计显示，对死亡率（优势比[OR]0.92，95%置信区间[CI]，0.80 - 1.05）、功能状态下降（OR 0.89，95% CI，0.77 - 1.03）和养老院入住率（OR 0.86，95% CI，0.68 - 1.10）的影响在统计学上无显著的有利差异且具有异质性。在较年轻的研究人群中观察到对死亡率有有益影响（OR 0.74，95% CI，0.58 - 0.94），但在较年长人群中未观察到（OR 1.14，95% CI，0.90 - 1.43）。在初始评估中包括临床检查的计划中，功能下降有所减少（OR 0.64，95% CI，0.48 - 0.87），但在其他试验中未减少（OR 1.00，95% CI，0.88 - 1.14）。没有单一因素能解释试验对养老院入住率的异质性影响。
基于包含临床检查的多维评估的多维预防性家访有潜力减轻老年人的残疾负担。对养老院入住率的影响具有异质性，可能取决于多种因素，包括人群因素、计划特征和医疗保健环境。
