Trials of preventive home visits

Study (country)	Intervention
Carpenter et al⁹ (UK)	Volunteers completed a scored activity of daily living questionnaire. Individuals with an increase in score >5 were referred to their general practitioner. Subjects with no disability were visited every 6 months, and those with some or severe disability every 3 months for a period of about 3 years. Controls received regular care Main objective: reducing medical, functional, mental, and social/environmental problems
Fabacher et al¹¹ (USA)	A home visit by a physician�s assistant or nurse to screen for medical, functional, and psychosocial problems, followed by a letter describing findings and recommendations, and follow up visits by trained volunteers at 4 month intervals for 1 year Controls received only telephone interviews at 4 month intervals to collect outcome data Main objective: improving health and functional status
Hall et al¹³ (Canada)	The intervention and control group all received standard long term care services, which included screening and preadmission assessment, arrangement or purchase of needed services and review at 3 months and at least yearly thereafter. In addition the intervention group received visits from the project nurse, who helped each subject to devise a personal health plan based on his or her needs in the areas of health care, substance use, exercise, nutrition, stress management, emotional functioning, social support and participation, housing, finances, and transportation. The frequency of visits to individual clients depended on their needs (duration 3 years) Main objective: assisting older adults in maintaining their total �wellbeing�
Hendriksen et al¹⁵ (Denmark)	An interview was carried out by a nurse using a structured questionnaire, and information on social and health conditions was collected. Corresponding visits were made every 3 months throughout the study (maximum 12 visits during a period of 3 years) Controls received regular care Main objective: reduction of mortality, and medical consumption
Luker¹⁷ (UK)	The intervention group received focused health visitor intervention once monthly for 4 months from a health visitor. The focus of the visits was generated by the subject�s health problems, which are subsumed under 10 headings: weight maintenance, mobility, dentition, sensory function, elimination, loneliness, performance of personal or household tasks, rest, medication, miscellaneous Controls received regular care Main objective: improving health problems and life satisfaction
McEwan et al¹⁸ (UK)	The test group received a home visit from a nurse at which an assessment lasting 45 minutes was made of: activities of daily living, social functioning, sensory function, mental and emotional problems, current medical problems, blood pressure, urinalysis, haemoglobin concentration, and compliance with medication Controls received regular care Main objective: resolving health and related problems and improving quality of life
Pathy et al¹⁹ (UK)	A screening questionnaire was sent to the participants. Depending on the answers and other information, the health visitor would arrange home visits and give any practical advice and health education that might be needed or arrange referral to the general practitioner or community service. The duration of the intervention period was 3 years Controls received regular care Main objective: improving quality of life and health status, and reducing mortality and use of all services
van Rossum et al²³ (Netherlands)	The intervention group was visited four times a year over a period of 3 years, with extra visits if necessary by a public health nurse. The nurse discussed health topics in a broad sense with the participants and gave information and advice Controls received regular care Main objective: improving the state of health (functional and mental state, wellbeing, and mortality)
Sorensen and Sivertsen²⁵ (Denmark)	During a home visit a social worker assessed housing conditions, economy, social support, and social network. In addition the need for health intervention was estimated by a physician, based on a general medical examination. Those found to need further treatment were referred to their general practitioner Controls received regular care Main objective: relieving unmet medical and social needs
Stuck et al²⁶ (USA)	The people in the intervention group were seen at home by gerontologic nurse practitioners who, in collaboration with geriatricians, evaluated problems and risk factors for disability, gave specific recommendations, and provided health education. During a period of 3 years, follow up visits were performed every 3 months Controls received regular care Main objective: preventing disability
Tinetti et al²⁹ (USA)	After a baseline assessment in their homes by the study nurse practitioner and physical therapist, based on the results of the assessment the subjects received the following interventions: behavioural recommendations, education about use of sedative-hypnotic agents, training in transfer skills, changes in environmental hazards, gait training, balance exercises, etc. The intervention phase lasted 3 months after the baseline assessment Controls received regular care plus social visits Main objective: reducing the risk of falling
Vetter et al³¹ (Gwent and Powys, UK)	Subjects were visited at home by a health visitor. The health visitors were instructed to interview patients and to keep notes according to usual health visiting practice. The health visitors were restricted to making one unsolicited visit a year (for a period of 2 years). They followed up patients who were in trouble at that visit Controls received regular care Main objective: improving wellbeing and physical, mental, and social functioning
Vetter et al³² (UK)	During a period of 4 years a health visitor visits the household at least once a year, for those not presenting any problems. Those elderly people who had problems were visited as often as was thought necessary by the health visitor. The health visitor first obtained a history of illness and than concentrated on four factors: nutrition, medical conditions, environment, and assessment and improvement of general muscle tone and fitness Controls received regular care Main objective: reducing the number of fractures
Wagner et al³³ (USA)	Intervention 1: subjects received a visit from a specially trained nurse or educator, aimed at reviewing risk factors for disability and falls. This resulted in a tailored intervention plan to address identified risk factors and motivate seniors to increase physical and social activity Intervention 2: a nurse visit focused on assessments and counselling relevant to prevention of cardiovascular disease, detection of breast and cervical cancer, influenza vaccination, and seat belt use Controls received regular care Main objective: reducing days of restricted activity due to illness