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Preventive home visits to home-dwelling older people and hospital admissions: a municipality-randomised intervention trial

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Abstract

Preventive home visits to older home-dwelling people have been part of national policy in Denmark since 1996. The aim was to evaluate whether education of home visitors and GPs was associated with hospital admission rates. In a population-based prospective controlled intervention trial in 34 municipalities, intervention municipality visitors received regular education during 3 years and GPs were introduced to a short assessment programme. Participation totalled 4,034 75- and 80-year-old home-dwelling persons, of which 3,132 (78%) had no mobility disability at baseline. Complete data on hospital services were obtained for all participants. No difference was observed in time to first admission between older people living in the intervention municipalities compared with people living in the control municipalities, HR 0.93 (95%CI: 0.85, 1.02, P = 0.17). Duration of first hospital stay was the same in the two groups (7.3 days). The mean number of admissions was not associated with intervention. Accepting and receiving home visits was associated with a reduced risk of hospital admission, HR 0.84 (95%CI: 0.76, 0.92), especially among the initially disabled. Hospital admission rates were associated with functional decline patterns. Persons experiencing catastrophic and progressive decline had the highest risk. Persons experiencing reversible functional decline were more often hospitalised in the intervention municipalities, and fewer persons living in the intervention municipalities experienced progressive decline. Education of primary care professionals was not associated with risk for first hospital admission among all older people living in the community, but may be associated with older people’s different functional decline patterns.

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Acknowledgments

We thank all participating municipalities and Eva Jepsen, Lisbeth Villemoes Sørensen and Annette Johannesen for following up on the questionnaires. We are indebted to Christian Cato Holm for data management. This study was supported by grants from the Danish Ministry of Social Affairs, the Danish Medical Research Council, the Research Foundation for General Practice and Primary Care, the Eastern Danish Research Forum, and the County Value-Added Tax Foundation. None of these funding sources have any involvement in study design, data collection, data analysis, interpretation of data, writing of the paper or the decision to submit for publication.

Conflict of interest statement

None. The corresponding author has full access to all the data in the study and has taken final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Department of General Practice, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark

    M. Vass

  2. Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

    C. Hendriksen & K. Avlund

  3. Department of General Practice, Institute of Public Health, University of Aarhus, Aarhus, Denmark

    J. L. Thomsen

  4. Department of Biostatistics, Institute of Public Health, University of Aarhus, Aarhus, Denmark

    E. T. Parner

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  1. M. Vass
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  2. C. Hendriksen
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  3. J. L. Thomsen
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  4. E. T. Parner
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  5. K. Avlund
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Correspondence to M. Vass.

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Vass, M., Hendriksen, C., Thomsen, J.L. et al. Preventive home visits to home-dwelling older people and hospital admissions: a municipality-randomised intervention trial. Eur J Ageing 5, 67–76 (2008). https://doi.org/10.1007/s10433-007-0069-x

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