Preventive Home Visits

The effects of home visitation programs to prevent functional decline in elderly persons have been inconsistent, and the value of these programs is controversial. To evaluate the effect of preventive home visits on functional status, nursing home admission, and mortality. Studies published in English, French, German, Italian, or Spanish reporting randomized trials of the effects of preventive in-home visits in older people (mean age >70 years) living in the community were identified through searches of MEDLINE, PSYCHINFO, and EMBASE (January 1985--November 2001). We also searched the Cochrane Controlled Trials Register, checked reference lists of earlier reviews and book chapters, searched conference proceedings and specialty journals, and contacted experts. We screened 1349 abstracts and excluded those that did not test in-home interventions or in which the mean age of the study population was younger than 70 years. After further exclusions, 17 articles describing 18 trials were analyzed. Two reviewers independently screened abstracts. Discrepancies were resolved by consensus with a third reviewer. For each included trial, we extracted data on the study population and the characteristics of the intervention. Two of us extracted information on 3 end points: nursing home admissions, mortality, and functional status. One of us assessed trial quality, including an examination of the method of randomization, blinding of caregivers and research staff ascertaining outcomes, and proportion of patients included in analyses of the 3 end points. The 18 trials included 13 447 individuals aged 65 years and older. The effect on nursing home admissions depended on the number of visits performed during follow-up. The pooled relative risk (RR) was 0.66 (95% confidence interval [CI], 0.48-0.92) for trials in the upper tertile (>9 visits) but was 1.05 (95% CI, 0.85-1.30) in the lower tertile (0-4 visits). Functional decline was reduced in trials that used multidimensional assessment with follow-up (RR, 0.76; 95% CI, 0.64-0.91) but not in other trials (RR, 1.01; 95% CI, 0.92-1.11). Functional decline was reduced (RR, 0.78; 95% CI, 0.64-0.95) in trials with a control group mortality rate in the lower tertile (3.4%-5.8%) but not (RR, 0.98; 95% CI, 0.84-1.13) in those with a control-group mortality rate in the upper tertile (8.3%-10.7%). A beneficial effect on mortality was evident in younger study populations (RR, 0.76; 95% CI, 0.65-0.88 for ages 72.7-77.5 years) but not in older study populations (RR, 1.09; 95% CI, 0.92-1.28 for ages 80.2-81.6 years). Preventive home visitation programs appear to be effective, provided the interventions are based on multidimensional geriatric assessment and include multiple follow-up home visits and target persons at lower risk for death. Benefits on survival were seen in young-old rather than old-old populations.

Background To promote healthy ageing, it is crucial to involve older adults in social planning. Preventive home visits allow older adults to express their opinions, with home visitors playing a key role in gathering and relaying this information to decision‐makers. Thus, highlighting the perspectives of home visitors is essential for maximising the utility of the collected information. Therefore, the purpose of this study was to gain a deeper understanding of important aspects regarding the utilisation of information from preventive home visits to create a society that promotes healthy ageing. Methods Five online focus group discussions were conducted with 16 home visitors from 15 municipalities representing various parts of Sweden. The discussion material was analysed with a focus on the content of the discussions. Results The analysis resulted in a main category: engaging in communication to promote healthy ageing—acting as the ‘spider in the web’ and advocating for older adults . Five subcategories were identified, highlighting the utilisation of information from preventive home visits for promoting healthy ageing: using older adults’ needs and capabilities as a starting point ; empowering older adults to make their voices heard ; compiling information to efficiently reach out ; having people in leading positions close by ; and receiving feedback on proposals. Conclusions Utilising information from preventive home visits to promote healthy ageing requires engagement from the home visitor, the older adults and a committed organisation. One critical aspect is the dialogue during the visit, which empowers the older adult and enables the home visitor to obtain information. Another important aspect is the home visitor’s engagement in communicating the information to actors who can promote healthy ageing in society. Finally, an organisation where leaders are available and give feedback on proposals based on information compiled during home visits is essential to promote healthy ageing.

Effects of preventive home visits on older people's use and costs of health care services: A systematic review

IntroductionSocial participation can have a positive impact on health; however, physical challenges can be hindrances. During a preventive home visit a health professional (visitor) assesses different aspects of physical, mental and social health. However, there might be a challenge for the visitor to discover the interrelationship between physical factors that hinder social participation. Therefore, the aim of this study was, in the context of preventive home visits, to identify physical factors which can hinder older persons from taking part in social contexts. MethodsCross-sectional register data from preventive home visits to older persons (n = 1245, ≥77 years old, without home care) was used. Data was collected during a period of 17 months, in seven Swedish municipalities. Logistic regression was used to analyze the association between physical factors and the item physical problems hindering social participation. ResultsThe mean age was 78.8 (standard deviation 1.8 years), and 55% were women. The physical factors significantly associated with physical problems hindering taking part in social contexts were: having urinary incontinence (women only), having pain, impaired endurance and using a mobility device. ConclusionsThis study provides insights into how to make the best use of the questions asked during preventive home visits, in order to enable older persons to take part in social contexts. The results recognize the importance of taking into account physical challenges to be able to support social participation. Furthermore, considering physical challenges for social participation on both an individual and a societal level might reduce inequalities among older persons.

This study aims at a description of the current position of preventive home visits to the elderly by community nurses in The Netherlands. Over a period of 8 weeks, a representative sample of 108 community nurses and 49 community nursing auxiliaries at 47 different locations paid a total number of 215 preventive home visits to elderly people. Clients' characteristics, the nature of care delivered by the nurse, and the length of the home visit were recorded for each home visit. The results suggested that community nurses and nursing auxiliaries spent very little time on preventive home visits. During the home visits, both types of nurses tried to increase the self-care agency of the elderly by giving education or advice. Furthermore, community nurses often paid more attention to the assessment and examination of existing or emerging self-care deficits of the elderly people visited than nursing auxiliaries. In spite of the fact that the importance of preventive care for the elderly is recognized, resources are scarce. It is therefore recommended that more research be carried out on the cost effectiveness of preventive home visits.

The transition to sustainable tourism in the European Union (EU) is increasingly shaped by green and digital transformation. However, the efficient use of local natural, cultural, human, and technological resources remains vital for enhancing sustainability and improving quality of life. This article examines how smart tourism destinations can operationalize sustainability through data-driven tools, stakeholder collaboration, and territorial assets. Using the SMART Sustainability Framework, it analyzes key indicators such as tourism intensity, digitalization levels, and green initiative adoption, with a focus on newer EU Member States. Case studies from Ljubljana, Gothenburg, Valencia, and Madeira illustrate varied approaches to integrating local resources via ICT, participatory governance, and sustainable mobility. Comparative analysis highlights significant disparities, with High Performers like Slovenia and Spain aligning digital innovation with local sustainability goals. The article concludes with policy recommendations to strengthen local capacities, scale digital tools, and promote place-based strategies for more inclusive and resilient tourism development.

The aging process is a continuum throughout life and often associated with deterioration of body function as well as accumulation of chronic disabilities and of disease. The impact of nutritional status on morbidity and mortality is unquestioned. Malnutrition increases the risk for frailty and nutritional deficits can influence immune status, response to medical treatments and recovery from acute illnesses, including surgery. Health-promoting interventions implemented individually, such as exercise programs, preventive home visits, comprehensive geriatric evaluation and management, and attention to adequate nutrition with or without nutritional supplements, have been shown in separate studies to be both feasible and effective in reducing age-related deterioration. Protein and its constituent amino acids (AA) are key components of any healthy diet. Sarcopenia, the slow but progressive loss of lean muscle mass associated with advancing age, has been the focus of many studies but there is no clear-cut answer to the question of how to restrain the process. The more general question of how the requirements for protein and specific AA change with age continues to be investigated. A shift towards studying the efficacy and safety of specific AA or combination of AA that may sustain and/or enhance physiologic processes, ranging from specific tissue metabolism to overall function (e.g. exercise performance, immune function, cognition, and chronic disease development) has occurred. This review focuses on recent studies examining the use of specific AA or mixtures as supplements in the elderly and whether/how AA may assist in the maintenance of health and independence.

Keeping elderly people in their own homes generally is accepted as desirable, and it seems logical that home health care visits could help to achieve this goal. This meta-analysis of 13 randomized, controlled studies was undertaken to determine whether elders benefit …

BackgroundOften preventive measures are not accessed by the people who were intended to be reached. Programs for older adults may target men and women, older adults, advanced old age groups and/or chronically ill patients with specific indications. The defined target groups rarely participate in the conception of programs or in the design of information materials, although this would increase accessibility and participation. In the German “Reaching the Elderly” study (2008–2011), an approach to motivating older adults to participate in a preventive home visit (PHV) program was modified with the participatory involvement of the target groups. The study examines how older men and women would prefer to be addressed for health and prevention programs.MethodsFour focus groups (N = 42 participants) and 12 personal interviews were conducted (women and men in 2 age groups: 65–75 years and ≥ 76 years). Participants from two districts of a major German city were selected from a stratified random sample (N = 200) based on routine data from a local health insurance fund. The study focused on the participants’ knowledge about health and disease prevention and how they preferred to be approached and addressed. Videos of the focus groups were recorded and analysed using mind mapping techniques. Interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis.ResultsA gender-specific approach profile was observed. Men were more likely to favor competitive and exercise-oriented activities, and they associated healthy aging with mobility and physical activity. Women, on the other hand, displayed a broader understanding of healthy aging, which included physical activity as only one aspect as well as a healthy diet, relaxation/wellness, memory training and independent living; they preferred holistic and socially oriented services that were not performance-oriented. The “older seniors” (76+) were ambivalent towards certain wordings referring to aging.ConclusionsOur results suggest that gender-specific needs must be considered in order to motivate older adults to participate in preventive services. Age-specific characteristics seem to be less relevant. It is more important to pay attention to factors that vary according to the individual state of health and life situation of the potential participants.

Most geriatric assessment instruments have been developed in the English language. Translated versions might differ in their psychometric properties. We analyzed the test-retest reliability and internal consistency of a German instrument for multidimensional geriatric assessment that was based on a newly developed English version. A group of 100 over 75-year-old community-dwelling persons (mean age 83.0 years, 81% women) in Hamburg (n = 26) and Ulm (n = 51), Germany, and Berne (n = 23), Switzerland was interviewed twice by the same trained interviewers with a one week interval. We administered questions on general health, chronic disorders, basic and instrumental activities of daily living, urinary incontinence, nutrition, falls, pain, the social support/network and preventive care measures. In addition, the Functional Status Questionnaire, the Physical Activity Scale for the Elderly, the Geriatric Oral Health Assessment Index, the Visual Function Questionnaire, the Hearing Handicap Inventory for the Elderly and the Geriatric Depression Scale were administered. Cohen's kappa was good to excellent (0.64 < or = kappa < or = 0.89) with only three exceptions (pain questions, kappa = 0.53; questions on preventive care services, kappa = 0.51; and one of the questions on recent falls, kappa = 0.44). Cronbach alpha (internal consistency) was good to excellent for all domains (0.76 < or = alpha < or = 0.95). The study results confirm good test-retest reliability of the German version of this multidimensional geriatric assessment instrument. Adapted versions of this instrument can be used for different purposes, e.g., preventive home visits, outpatient geriatric assessments or epidemiological studies in older persons.

To assess the influence of the COVID-19 pandemic on hospital admissions (HA), intra-hospital deaths (HD), and intra-hospital lethality rates (HL) related to respiratory diseases (RD) other than COVID-19 in Brazil. This observational time-series study was conducted through comparative analyses of the HA, HD, and HL related to non-COVID-19 RD registered between March and December 2020 by the Brazilian Unified Public Health System on the DataSUS Tabnet platform, using as reference the values recorded in the same period of 2019 and those projected by linear regression methods for 2020, considering the period from 2015 to 2019. The adopted statistical significance level was 5% (p < 0.05). Compared to 2019, in 2020, there was a 42% decrease in HA and a 7.4% decrease in total HD related to non-COVID-19 RD, followed by a 60% increase in HL associated with this group of diseases. The HA and HL registered in 2020 differed significantly from the projected trend for that year by linear regression (p < 0.05). Of note, a significant reduction in hospitalizations due to asthma (-46%), chronic obstructive pulmonary disease (-45%), bronchiectasis (-54%), pneumonia (-46%), and acute bronchitis (-73%) was observed. During the first 8 months of the pandemic, there was a decline in HA and an increase in HL related to non-COVID-19 RD in Brazil, which can hypothetically reflect logistical challenges and delays in the management of this group of diseases.

As global populations age, there is increasing demand for effective, person-centered healthcare solutions that support older adults to age in place. Home healthcare has emerged as a crucial strategy to address the complex health and social needs of older adults while reducing reliance on institutional care. This umbrella review aimed to synthesize evidence from existing systematic reviews and meta-analyses on home healthcare services and interventions targeting older adults. A comprehensive search was conducted across five databases and gray literature sources, including Google Scholar, for reviews published between 2000 and 2025. The review followed the Joanna Briggs Institute methodology and PRISMA statement. Twenty reviews met the inclusion criteria, encompassing a total of over 3.1 million participants. Interventions were grouped into four categories: integrated and multidisciplinary care, preventive and supportive home visits, technological and digital interventions, and physical, transitional, and environmental support. Results indicated that many interventions led to improved health outcomes, including enhanced functional ability, reduced hospital readmissions, and increased satisfaction. However, effectiveness varies depending on the intervention type, delivery model, and population. Challenges such as caregiver burden, digital exclusion, and implementation in diverse settings were noted. This review highlights the promise of home healthcare interventions and underscores the need for context-sensitive, equitable, and scalable models to support aging populations.

The knowledge, perception, and behavior of young people toward ecotourism are important for the sustainable development of this sector. The purpose of this research is to evaluate and analyze the knowledge of young Romanian students about ecotourism and the main ecotourism destinations in Romania, their behavior in relation to the practice of this form of sustainable tourism at the local level in the last 2 years (2020 and 2021), and people’s use of the Internet for planning holidays and digital applications while traveling in nature. A quantitative research was conducted based on a self-administered questionnaire, structured in 13 sections on ecotourism, to which were added the sociodemographic data of the respondents. The conclusions of the research are that young people know well the main ecotourism destinations in Romania; they choose them according to the beauty of the landscape, multitude of outdoor activities, and the hospitality of the hosts. In the last 2 years of the pandemic, young people have visited several times the main existing ecotourism destinations locally, with an average vacation duration of 1–3 days. The Internet remains the main source of information, and in the field, they use mobile applications that allow the download of digital maps and recognize different plant species. By integrating various activities in nature, in close connection with the local culture, ecotourism can contribute to the sustainable use of local tourism resources. This study provides a detailed and realistic picture of the knowledge and the type of ecotourism experience that young people want. The implications are theoretical and managerial, highlighting the importance of assessing the preferences of young ecotourists, as a basis for developing ecotourism strategies, sustainable use of local tourism resources, and management of protected areas.

Lainawa J, Santa NM, Pandey J, Bagau B. 2015. Utilization of local resource as industrial raw materials and alternative poultry feed to improve organic quail farm’s revenue in Sonder, District of Minahasa. Pros Sem Nas Masy Biodiv Indon 1 (2): 383-387. A limited supply of feed, in addition to baby chicks, is on of main problems in quail poultry. More than 80% of the total cost is spent on feed expenditure. Furthermore, farmers are suffering from the highly fluctuating price of the feed which is mostly supplied by big companies. It is, therefore, necessary to develop a new alternative of feed for quail farms from local resources. The purpose of research is to determine the type and amount of feed compositions required accordingly by the quails. Local resources were used, thus reducing the feeding cost, which consequently would increase the revenues. Furthermore, this might also open business opportunity in poultry feed industry. This research was conducted using trial and error method, by categorizing some local feed resources, then analyzing the composition of the feed. This study has obtained feed ingredients and composition which are suitable for quail farms. The feed is composed of corn flour, fine bran, coconut meat, and fish meal. In conclusion, the use of local feed resources in appropriate composition can increase revenue by 34.56%, thus the local resources can be used as raw materials for quail farm feed.

BackgroundAmbulatory geriatric rehabilitation (AGR) is a multidisciplinary outpatient prevention program designed to decrease hospitalisation and dependence on nursing care in multimorbid patients ≥70 years of age. We evaluated the effectiveness of AGR compared to usual care on progression of nursing care levels, nursing home admissions, hospital admissions, incident fractures, mortality rate and total cost of care during a one-year follow-up period.MethodsAnalyses were based on claims data from the health insurance company AOK Nordost. Propensity Score matching was used to match 4 controls to each person receiving the AGR intervention.ResultsA total of 632 AGR participants and 2528 matched controls were included. The standardized mean difference of matching variables between cases and controls was small (mean: + 1.4%; range: − 4.4/3.9%). In AGR patients, the progression of nursing care levels (+ 2.2%, 95%CI: − 0.9 /5.3), nursing home admissions (+ 1.7%, 95%CI: − 0.1/3.5), hospital admissions (+ 1.1%, 95%CI: − 3.2/5.4), incident fractures (+ 11.1%, 95%CI: 7.3/15) and mortality rate (+ 1.2%, p = 0.20) showed a less favourable course compared to controls. The average total cost per AGR participant was lower than in the control group (− 353€, 95%CI: − 989€/282€), not including costs for AGR.ConclusionsAnalysis based on claims data showed no clinical benefit from AGR intervention regarding the investigated outcomes. The slightly worse outcomes may reflect limitations in matching based on claims data, which may have insufficiently reflected morbidity and psychosocial factors. It is possible that the intervention group had poorer health status at baseline compared to the control group.Trial registrationGerman Clinical Trials Register DRKS00008926, registered 29.07.2015.