Denise Kendrick

Effectiveness of home based support for older people: systematic review and meta-analysis

Abstract Objective: To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. Design: Systematic review and meta-analysis of 15 studies of home visiting. Participants: Older people living at home, including frail older people at risk of adverse outcomes. Outcome measures: Mortality, admission to hospital, admission to institutional care, functional status, health status. Results: Home visiting was associated with a significant reduction in mortality. The pooled odds ratio for eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, “at risk” older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardised effect size 0.06; −0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; −0.07 to 0.17). Conclusion: Home visits to older people can reduce mortality and admission to long term institutional care. What is already known on this topic The benefits of regular, preventive home visits to older people are the subject of controversy A recent systematic review found no clear evidence that preventive home visits were effective What this study adds This meta-analysis of 15 trials shows that home visiting can reduce mortality and admission to institutional care among older people

Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis

AIMS To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.

Measuring the Population Burden of Injuries—Implications for Global and National Estimates: A Multi-centre Prospective UK Longitudinal Study

Ronan Lyons and colleagues compared the population burden of injuries using different approaches from the UK Burden of Injury and Global Burden of Disease studies and find that the absolute UK burden of injury is higher than previously estimated.

A randomised controlled trial of general practitioner safety advice for families with children under 5 years

Abstract Objective: To assess effectiveness of general practitioner advice about child safety, and provision of low cost safety equipment to low income families, on use of safety equipment and safe practices at home. Design: Randomised, unblinded, controlled trial with initial assessment and six week follow up by telephone survey. Twenty families from intervention and control groups were randomly selected for a home visit to assess validity of responses to second survey. Setting: A general practice in Nottingham. Subjects: 98% (165/169) of families with children aged under 5 years registered with the practice. Interventions: General practitioner safety advice plus, for families receiving means tested state benefits, access to safety equipment at low cost. Control families received usual care. Main outcome measures: Possession and use of safety equipment and safe practices at home. Results: Before intervention, the two groups differed only in possession of fireguards. After intervention, significantly more families in intervention group used fireguards (relative risk 1.89, 95% confidence interval 1.18 to 2.94), smoke alarms (1.14, 1.04 to 1.25), socket covers (1.27, 1.10 to 1.48), locks on cupboards for storing cleaning materials (1.38, 1.02 to 1.88), and door slam devices (3.60, 2.17 to 5.97). Also, significantly more families in intervention group showed very safe practice in storage of sharp objects (1.98, 1.38 to 2.83), storage of medicines (1.15, 1.03 to 1.28), window safety (1.30, 1.06 to 1.58), fireplace safety (1.84, 1.34 to 2.54), socket safety (1.77, 1.37 to 2.28), smoke alarm safety (1.11, 1.01 to 1.22), and door slam safety (7.00, 3.15 to 15.6). Stratifying results by receipt of state benefits showed that intervention was at least as effective in families receiving benefits as others. Conclusions: General practitioner advice, coupled with access to low cost equipment for low income families, increased use of safety equipment and other safe practices. These findings are encouraging for provision of injury prevention in primary care. Key messages We assessed the effectiveness of general practitioner advice about child safety, and provision of low cost safety equipment to low income families, on safe practices at home The intervention increased safe behaviour and use of safety equipment The intervention was equally effective in families receiving means tested benefits as in those not receiving benefits The effectiveness of this intervention should be evaluated over longer periods, in other practices, and when delivered by other members of the primary healthcare team

Epidemiology of burn injuries in the East Mediterranean Region: a systematic review

BackgroundBurn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organizations East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken.MethodsMedline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations.ResultsSeventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%.ConclusionBurn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.

Preventing injuries in children: cluster randomised controlled trial in primary care

Abstract Objective: To assess the effectiveness of safety advice at child health surveillance consultations, provision of low cost safety equipment to families receiving means tested state benefits, home safety checks, and first aid training on frequencyand severity of unintentional injuries in children at home. Design: Cluster randomised controlled trial. Setting:36 general practices in Nottingham. Subjects:All children aged 3-12 months registered with participating practices. Interventions: A package of safety advice at child health surveillance consultations at 6-9, 12-15, and 18-24 months;provision of low cost safety equipment to families on means tested state benefits; and home safety checks and first aid training by health visitors. Outcome measures: Primary outcomes measures were frequency and severity of medically attended injuries. Secondary outcome measures were self reported safety practices, possession and use of safety equipment, knowledge and confidence in dealing with first aid, and perceptions of risk of injury and risk of hazards assessed by postalquestionnaire at baseline and follow up at 25 months. Results: At baseline, both groups had similar risk factors for injury, sociodemographic characteristics, safety practices, possession and use of safety equipment, knowledge and confidence in dealing with first aid, and perceptions of risk. No significant difference was found in frequency of at least one medically attended injury (odds ratio 0.97, 95% confidence interval 0.72 to1.30), at least one attendance at an accident and emergency department for injury (, 0.76 to 1.37), at least one primary care attendance for injury (0.75, 0.48 to 1.17), or at least one hospital admission for injury (0.69, 0.42 to 1.12). No significant difference in the secondary outcome measures was found between the intervention and control groups. Conclusions: The intervention package was not effective in reducing the frequency of minor unintentional injuries in children at home, and larger trials are required to assess the effect on more severe injuries.

Depressive symptoms in mothers of pre-school children--effects of deprivation, social support, stress and neighbourhood social capital.

BackgroundDepressive symptoms in mothers of young children can have serious consequences for the health of the child. In particular, children whose mothers are experiencing depressive symptoms are at significantly greater risk of poisoning and accidental injury. A mother’s risk of developing depressive symptoms has been shown to be related to socio-economic disadvantage, high levels of stress and a perceived lack of social support. Residents who perceive their neighbourhoods to be of low social capital are more likely to report poor mental health. The aim of this study was to investigate the relationship between maternal depressive symptoms, deprivation, social support, stress and neighbourhood social capital in a group of mothers living in deprived areas of Nottingham, United Kingdom (UK).Design and settingA postal questionnaire at entry to a randomised controlled trial (RCT) assessed socio-demographic characteristics and a second questionnaire, 21 months later, assessed depressive symptoms, perceived lack of social support, self-reported stress and individual-level assessment of neighbourhood social capital.ParticipantsA total of 846 mothers of young children living in deprived areas in Nottingham, UK, enrolled in the control group of an RCT.ResultsOne-third of mothers reported high levels of depressive symptoms. Neighbourhood-level deprivation and receiving means-tested benefits were independently associated with maternal depressive symptoms. A lack of social support and high levels of self-reported stress were also strongly associated with depressive symptoms. Individual-level assessment of neighbourhood social capital was not associated with depressive symptoms amongst mothers after adjusting for self-reported stress.ConclusionsNeighbourhood- and individual-level variables of deprivation and psychological distress are more important than mother’s assessment of the social capital of the neighbourhood in which she lives in determining the risk of depressive symptoms. Interventions aimed at supporting mothers of young children may be more effective at reducing the risks of depressive symptoms and consequent risks to the child’s health than interventions aimed at improving a neighbourhood’s social capital.

Which factors are associated with fear of falling in community-dwelling older people?

BACKGROUND fear of falling (FOF) is common in older people and associated with serious physical and psychosocial consequences. Identifying those at risk of FOF can help target interventions to both prevent falls and reduce FOF. OBJECTIVE to identify factors associated with FOF. STUDY DESIGN cross-sectional study in 1,088 community-dwelling older people aged ≥65 years. METHODS data were collected on socio-demographic characteristics, self-perceived health, exercise, risk factors for falls, FOF (Short FES-I), and functional measures. Logistic regression models of increasing complexity identified factors associated with FOF. RESULTS high FOF (Short FES-I ≥11) was reported by 19%. A simpler model (socio-demographic + falls risk factors) correctly classified as many observations (82%) as a more complex model (socio-demographic + falls risk factors + functional measures) with similar sensitivity and specificity values in both models. There were significantly raised odds of FOF in the simpler model with the following factors: unable to rise from a chair of knee height (OR: 7.39), lower household income (OR: 4.58), using a walking aid (OR: 4.32), difficulty in using public transport (OR: 4.02), poorer physical health (OR: 2.85), black/minority ethnic group (OR: 2.42), self-reported balance problems (OR: 2.17), lower educational level (OR: 2.01) and a higher BMI (OR: 1.06). CONCLUSIONS a range of factors identify those with FOF. A simpler model performs as well as a more complex model containing functional assessments and could be used in primary care to identify those at risk of FOF, who could benefit from falls prevention interventions.

The association between baseline characteristics and the outcome of foot lesions in a UK population with diabetes

Aims  To explore the relationships between time to healing of diabetic foot ulcers and baseline characteristics of both patients and their ulcers.

Validation of a home safety questionnaire used in a randomised controlled trial

Objective: To measure the validity of self reported safety practices from a questionnaire, completed by families participating in a home safety randomised controlled trial. Methods: The postal questionnaire was used to measure secondary outcomes in a randomised controlled trial. The answers to 26 questions that could be assessed by observation were checked by a home visit. Families were invited to take part in a “home safety check”; they were not told that the visit was part of a validation study. At the time of the visit the researcher was blind to the self reports in the questionnaires. Results: Sixty four questionnaires were validated by visits to 64 households. Percentage agreement ranged from 58% to 100%. Sensitivity was high (68% or above) for most safety practices. The positive predictive value was also high for most safety practices (78% or above for 15 of the 16 practices). Conclusions: This study found a fairly high degree of consistency between self reported data and actual observations. The findings from this relatively small study need confirmation from larger studies.