Whom Do Preventive Home Visits Help?

Whom Do Preventive Home Visits Help? O ver the past years, multiple reports have suggested that improved prevention might result in potential health benefits in older people.Major deficits have been identified in preventive care or health behavior in older persons.A U.S. study uncovered major deficits in use of preventive services in older people. 1 A study on health risk appraisal in three European countries reported large gaps in preventive care and in health behavior in older persons. 2 There is growing epidemiological evidence of the negative effect of risky behaviors on outcomes in older people.Lifestyle risk factors for disease and disability, such as smoking, alcohol use, lack of exercise, and poor nutrition, have been linked to greater use of healthcare services, suggesting that preventive interventions might not only improve health, but also reduce healthcare use. 3 There is convincing evidence that major adverse outcomes in older people, such as decline in functional status 4 and nursing home admission, 5 have been linked to multiple potentially modifiable risk factors.Moreover, discrete risk factors can be successfully modified.For example, provider education, provider alerts, and patient education have been shown to result in improved blood pressure control in older persons; 6 improving an unsafe home environment has been shown to successfully reduce falls in older persons with visual impairment.7 Therefore, it might be expected that a multidimensional program, combining assessment and intervention for multiple risk factors, would result in major benefits in health and healthcare use in older people.The results of Bouman et al., published in this issue of the Journal of the American Geriatrics Society, conflict with this hypothesis.8 The study showed no effect of a program of home assessments on functioning or other outcomes in elderly persons and, based on preliminary analyses, no effects on healthcare utilization either.These findings come in the wake of prior work that paints a mixed picture of the effects of such care.A systematic analysis published in 2002 found that overall pooled effects of randomized studies of in-home preventive visits were statistically nonsignificant but heterogeneous, because studies used different methods for selecting study populations and implementing interventions.9 Key factors associated with favorable outcomes included selection of a low-risk population, use of multidimensional assessments, and multiple follow-up home visits.What do the Bouman et al. and other studies published since 2002 add to those observations?