Visits are most useful for people aged ≥75

EDITOR—The systematic review by van Haastregt et al of trials of preventive home visits for people aged 65 or over reported that “no clear evidence was found in favour” of such visits.1 Some of the trials reviewed showed favourable effects in some of the five main outcome measures (physical functioning, psychosocial functioning, falls, admissions to institutions, and mortality), but most found no effect. However, the review shows that favourable outcomes were more prevalent in studies conducted in older subjects (≥75), although it does not comment on this. The table is constructed from the analysis they report.

Outcomes of physical functioning are the exception, with only one of the five favourable studies being in people aged 75 and over. This is not unexpected. It may be easier to improve physical functioning in the group aged 65 or over generally than in the group aged 75 or over specifically.

General practitioners in Australia have recently been funded for “75+ health assessments.” We have just concluded a randomised controlled trial of these assessments. A nurse visited 100 elderly people who were living in the community on two occasions, one year apart (50 control, 50 intervention). No interval assessment nor reminder was included in the protocol.2 Initial analysis found:

• Fewer people reported falls in the intervention group in the study year (12 v 22, P=0.055)

• Fewer people died in the intervention group (1 v 5, P=0.2)

• Physical functioning did not change (measured using Barthel index of activities of daily living)

• Psychosocial functioning improved (geriatric depression scale 15, Wilcoxon scores (rank sums) P=0.09).

Our study is consistent with the other published trials, showing modest improvement in the measured outcomes in the group aged 75 or over.

Van Haastregt et al call for either improved effectiveness of preventive home visits or their discontinuation. Their …