America has a large and growing elderly population. Most of these people hope to live independently as long as possible and avoid institutionalization. And it is believed that keeping these people in their homes results in lower health spending. An article in PLOS reports on a systematic review of research on the effect of home health visits for the elderly. (PLOS Article) The review covered over 60 randomized trials which evaluated interventions aimed at least partly at keeping the elderly living in the community. The outcomes examined included mortality, independent living, hospitalization, ER use, falls, physical and cognitive functioning, quality of life and depression. Some of the factors relating the intervention that were tested were frequency of visits, the thrust of the intervention, who did the visiting in terms of professional qualifications and follow-up period. In general, the interventions were poorly described, which makes understanding the theory behind the intervention and any causality difficult to ascertain.
Overall, the review suggested there was little positive benefit to these home visits. Mortality was not lower, the patients were not more likely to remain independently living for a longer period, hospitalizations were not lower, ER use was not lower, functioning was not higher, etc. There were some small effects in certain outcomes or for certain features of the intervention, but these were so small that their clinical benefit is dubious. As is usually the case, drawing systematic conclusions is made difficult by the lack of consistency in the interventions. It is certainly possible that if a consistent intervention, consistently implemented, were tested, it might show more definitive positive or negative results. But based on what has been studied to date, it appears that the most disappointing finding is that these approaches don’t seem to help keep people in their homes longer. That is bad news for the system and for the public payers who are largely responsible for the health care and institutionalization costs for these people.