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Preventive home visits postpone mortality: a controlled trial with time-limited results
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.ORCID iD: 0000-0002-3975-4868
Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
IMS, Institutet för metodutveckling i socialt arbete, Socialstyrelsen.
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2006 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 6, no 220Article in journal (Refereed) Published
Abstract [en]

Background: There is a debate on whether preventive home visits to older people have any impact. This study was undertaken to investigate whether preventive home visits by professional health workers to older persons can postpone mortality in a Swedish context.

Method: A controlled trial in a small community in the north of Sweden. Participants are healthy pensioners aged 75 years and over. 196 pensioners were selected as the intervention group and 346 as the control group. The intervention, two visits per year, lasted two years.

Results: During the intervention, mortality was 27 per 1000 in the intervention group and 48 per 1000 in the control group. The incidence rate ratio for the control group IR2000–2001 was 1,79 (95%CI = 0,94–3,40). Analysing the data with an "on treatment approach" gave a significant result, 2,31 (95%CI = 1,07–5,02) After the trial the difference between the groups disappeared.

Conclusion: Preventive home visits in a healthy older population can postpone mortality in a Swedish context if they are carried out by professional health-workers in a structured way. When the home visit programme ended the effect on mortality disappeared. These findings are dependent on contextual factors that make it difficult to form general policy recommendations.

Place, publisher, year, edition, pages
BIO Med Central Ldt , 2006. Vol. 6, no 220
Keyword [en]
Prevention, old age, mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
hälso- och sjukvårdsforskning
Identifiers
URN: urn:nbn:se:umu:diva-25641DOI: 10.1186/1471-2458-6-220OAI: oai:DiVA.org:umu-25641DiVA: diva2:232791
Available from: 2009-08-28 Created: 2009-08-26 Last updated: 2015-04-29Bibliographically approved
In thesis
1. An ounce of prevention is worth a pound of cure: preventive home visits among healthy seniors
Open this publication in new window or tab >>An ounce of prevention is worth a pound of cure: preventive home visits among healthy seniors
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Ett hekto förebyggande insatser är värt ett kilo bot : förebyggande hembesök för seniorer
Abstract [en]

The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers.

An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over.

The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results.

Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling.

Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked.

Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2009. 65 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1278
Keyword
preventive home visits, mortality, care utilisation, senior production, cost effectiveness, realist synthesis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
hälso- och sjukvårdsforskning
Identifiers
urn:nbn:se:umu:diva-25653 (URN)978-91-7264-825-8 (ISBN)
Distributor:
Epidemiologi och folkhälsovetenskap, 901 87, Umeå
Public defence
2009-09-18, Rum 135, Allmänmedicin, Byggnad 9A, Norrlands Universitetsjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-08-28 Created: 2009-08-26 Last updated: 2015-04-29Bibliographically approved

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Sahlen, Klas Göran Sahlen

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