[Effectiveness of preventive house visits for elderly people : Systematic assessment of current literature].

Background: Preventive home visits (PHV) document health resources and risks in the domestic environment in order to derive preventive recommendations. An earlier review did not yield reliable proof of their efficacy for the elderly; however, PHV are used increasingly more as a municipal service in Germany.
Objective: This article evaluates the efficacy of PHV by means of evidence-based criteria.
Material and Methods: Independent of the reason, randomized controlled studies (RCT) and systematic reviews on PHV in the elderly (60+ years) that were published after 2004 were identified by means of searching pertinent literature databases. The outcomes evaluated were mortality, hospitalization, admission to nursing home, functional status, falls and quality of life.
Results: The 12 RCT included (for the first time including a German trial) showed a high clinical heterogeneity, good methodological quality and only few bias potentials. As few as 6 out of the 12 RCT showed positive effects for individual outcomes, rarely exceeding the period of the intervention and partly limited to individual subgroups; however, almost no negative effects were reported. The four review articles included did not show any reliable proof of efficacy of PHV regarding any of the evaluated outcomes either.
Conclusion: In the current literature no clear proof of the efficacy of PHV could be identified. No structure or process features having an efficacy regarding several outcomes could be derived either. Thus, the current use of PHV is still being made without any clear evidence of efficacy.