Home Care Helps Keep
Elderly Healthy, Independent
Excerpt By Merritt McKinnney, Reuters Health

NEW YORK (Reuters Health) - In contrast to a report published last year, a new UK study shows that home visits may help the elderly live longer and reduce the odds that they will have to move to a nursing home or other institution.

According to the study's authors, the results call into question the wisdom of discontinuing home visits to the elderly, as some experts have recommended.

``The provision of routine home visits to older people should be considered seriously by policymakers,'' according to the study's lead author, Dr. Ruth Elkan of the University of Nottingham, England.

Noting that there is widespread support for helping older people stay in their own homes, she told Reuters Health, ``Our research suggests that routine home visits to all who are aged 65 and older may be an effective preventive strategy--a way of reducing admissions to residential care.''

Elkan and her colleagues decided to review studies of home care because the research on its benefits has been mixed. In the early 1990s, a review of studies detected several benefits of home care, including reductions in deaths as well as in admissions to hospitals and nursing homes.

Another review published last year, however, did not show any consistent benefits of home care for the elderly.

In the September 29th issue of the British Medical Journal, Elkan and her colleagues report on their review of 15 studies of the effects of home care on the elderly.

According to the researchers, home care reduced the risk of death among the elderly by 24% to 28%. Home visits were also linked to a 35% reduction in nursing-home admissions among all elderly patients and a 45% drop among frail seniors.

The elderly who received home care did not have a lower risk of being hospitalized, however.

The authors suggest that two opposite effects might explain why home care did not reduce hospitalizations. According to the report, home visits might have identified individuals in need of hospital care whose needs would have gone undetected without home care. But Elkan and colleagues point out that home care might have reduced the need for some hospital admissions.

The main reason that Elkan's team reached different conclusions than the most recent review of home care is that the researchers used a different method of analyzing previous studies, according to Dr. Matthias Egger at the University of Bristol.

The 2000 review assigned a ``vote'' to each study based on whether or not it demonstrated benefits of home care, he explains in an accompanying editorial. Egger called this method ''clearly unsound.''

In contrast, Elkan's team used a technique called meta-analysis, which involves pooling the data from a number of studies to reach an overall conclusion.

``Trials and meta-analyses show that preventive home visits can work,'' Egger writes. The next challenge, according to the editorialists, is to determine which aspects of home care are most effective as well as which patients are most likely to benefit from them.

According to Dr. J. Clark, of the University of Wales, the intangible benefits of home care, such as well-being and quality of life, make it difficult to evaluate its benefits with clinical trials.

``To dismiss the effectiveness of health visiting on the basis of currently available studies of home visiting is like dismissing the effectiveness of aspirin as a remedy for headache on the basis of a study in which the dose was 10 milligrams and the headache was caused by a brain tumour,'' Clark writes in another editorial.

SOURCE: British Medical Journal 2001;323:708, 719-725.

Reference Source 89

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