Articles
Correspondence to: Andrew D Beswick, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK
[email protected]
Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis
Study setting Number of participants (intervention: control) Mean age in intervention group (% men) Mortality rate
Intervention Intensity Control group activity
Follow up Outcomes Losses to follow-up
Geriatric assessment general elderly people Burton and colleagues 199527 USA 1989
Primary care (HMO) N=4195 (2105:2090) Mean age 74 years (36%) Mortality rate 5·1%
Assessment mailed to primary care physician as focus of preventive visit Follow-up counselling within 6 months 24 months with 4 contacts scheduled Control group received pamphlet on good health practices
Follow-up 24 and 48 months Death, living at home, institutionalisation, QWB (Kaplan) Losses to follow-up 5·2–16·7%
Byles and colleagues 200428* Australia 1997
Veterans and war widows N=1569 (942:627) Mean age 77 years (about 3%) Mortality rate 4·0%
Home-based assessment by nurse, social worker, psychologist, therapist, and occupational therapist. Information provided to individual and GP. Telephone follow-up and 6 or 12 monthly visit 36 months with 3 or more visits Control group received usual care
Follow-up 36 months Death, living at home, permanent nursing home admission, SF-36 physical function, hospital admission, falls Losses to follow-up 12·0–20·1%
Carpenter and Demopoulos 199029 UK date not stated
Primary care N=539 (272:267) Mean age 80·2 years (35%) Mortality rate 7·4%
Home visits by lay volunteers for activities of daily living dependency surveillance. Referrals to GP if specified increase recorded 36 months with approximately 6 to 12 visits Control group completed baseline ADL questionnaire
Follow-up 36 months Death, living at home, long term nursing care, Winchester ADL, hospital admissions, falls Losses to follow-up 9·1%
Clarke and colleagues 199230 UK 1985
General practice N=523 (261:262) Mean age 81 years (not known) Mortality rate 7·5%
Social intervention initiated at home by lay community worker. Assistance tailored to request for help 15–24 months with 3 or more visits Control group completed baseline interview only
Follow-up 36 months Died or moved away, living at home, admitted to institution, Jagger ADL Losses to follow-up 0·2%
Eekhof and colleagues 200031 Netherlands date not stated
General practice N=1470 (732:738)† Mean age 81·3 years (37%) Mortality rate 3·9%
Home or surgery based screening for hearing, visual, continence, and mobility disorders by general practitioner. Interventions as appropriate 1 visit Control group had intervention delayed by 12 months
Follow-up 12 months Death, living at home, nursing home admissions, prevalence of mobility disorders Losses to follow-up 4·9–11·8%
Fabacher and colleagues 199432 USA 1988
Armed services veterans N=254 (131:123) Mean age 73·5 years (98%) Mortality rate 3·1%
Home based assessment by physician’s assistant or nurse. Review by geriatrician. Education, recommendations, and referrals. Follow-up by volunteers and research staff 12 months with approximately 3 visits Control group received follow-up telephone interviews
Follow-up 12 months Death, living at home, nursing home admissions, Katz ADL, hospital admissions, falls Losses to follow-up 12·6–20·1%
Fletcher and colleagues 200433* UK 1995
General practice N=43,219 (21 762:21 457)† Mean age 81·5 years (36%) Mortality rate 7·6%
Brief assessment questionnaire followed by assessment at home or GP surgery by nurse. Appropriate referrals to clinical, medical and social services One detailed assessment visit Control group received brief questionnaire and detailed examination by study nurse for those who triggered need for full assessment
Follow-up 36 months, hospital 24 months Death, living at home estimated, institution admissions, SIP mobility, hospital admissions Losses to follow-up 0–17·8%
Fox and colleagues 199734 USA 1994
Community living N=237 (118:119) Mean age not stated (about 30%) Mortality rate estimated
