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1.  Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review 
BMC Geriatrics  2016;16:5.
Background
Although rehabilitation for older patients has the potential to improve function and prevent admission to nursing homes, returning home after discharge is not possible for all patients. Better understanding of patient factors related to discharge home may lead to more realistic rehabilitation goals, more targeted rehabilitation interventions and better preparation of both patient and informal caregiver for discharge. Various studies provided insight into factors related to home discharge after stroke rehabilitation, but we still lack insight into factors related to home discharge in non-stroke patients. Therefore, the aim of this review is to provide an overview of factors influencing home discharge in older non-stroke patients admitted to an inpatient rehabilitation unit.
Methods
A systematic literature search was executed in the databases PubMed, EMBASE, CINAHL and Web of Science to retrieve articles published between January 2000 and October 2015. The search focused on factors related to home discharge after rehabilitation for older patients. Studies were included if home discharge after rehabilitation was assessed as an outcome measure and if the non-stroke population was, on average, 65 years or older and admitted to an inpatient rehabilitation unit.
Results
Eighteen studies were included. The methodological quality was moderate to good in 15 studies. The factors significantly associated with home discharge are younger age, non-white ethnicity, being married, better functional and cognitive status, and the absence of depression.
Conclusions
Because various factors are significantly associated with home discharge of older non-stroke patients after rehabilitation, we recommend assessing these factors at admission to the rehabilitation unit. Further research into the factors that lack sufficient evidence concerning their association with home discharge is recommended.
Electronic supplementary material
The online version of this article (doi:10.1186/s12877-016-0187-4) contains supplementary material, which is available to authorized users.
doi:10.1186/s12877-016-0187-4
PMCID: PMC4709872  PMID: 26755206
Aged; Geriatrics; Rehabilitation; Patient discharge
2.  Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial 
BMJ : British Medical Journal  2000;321(7267):994-998.
Objective
To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community.
Design
Randomised controlled trial with 18 months of follow up.
Setting
Six general practices in Hoensbroek, the Netherlands.
Participants
316 people aged 70 and over living in the community, with moderate impairments in mobility or a history of recent falls.
Intervention
Five home visits by a community nurse over a period of one year. Visits consisted of screening for medical, environmental, and behavioural factors causing falls and impairments in mobility, followed by specific advice, referrals, and other actions aimed at dealing with the observed hazards.
Main outcome measures
Falls and impairments in mobility.
Results
No differences were found in falls and mobility outcomes between the intervention and usual care groups.
Conclusion
Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community. Because falls and impairments in mobility remain a serious problem among elderly people, alternative strategies should be developed and evaluated.
PMCID: PMC27508  PMID: 11039967
3.  Effects of preventive home visits to elderly people living in the community: systematic review 
BMJ : British Medical Journal  2000;320(7237):754-758.
Objective
To assess the effects of preventive home visits to elderly people living in the community.
Design
Systematic review.
Setting
15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register.
Main outcome measures
Physical function, psychosocial function, falls, admissions to institutions, and mortality.
Results
Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. Favourable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects.
Conclusions
No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community. It seems essential that the effectiveness of such visits is improved, but if this cannot be achieved consideration should be given to discontinuing these visits.
PMCID: PMC27318  PMID: 10720360
4.  Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review 
BMJ : British Medical Journal  1998;316(7149):1939-1944.
Objective: To investigate whether for patients with incurable cancer comprehensive home care programmes are more effective than standard care in maintaining the patients’ quality of life and reducing their “readmission time” (percentage of days spent in hospital from start of care till death).
Design: Systematic review.
Methods: A computer aided search was conducted using the databases of Medline, Embase, CancerLit, and PsychLit. The search for studies and the assessment of the methodological quality of the relevant studies were performed by two investigators, blinded from each other. Prospective, controlled studies investigating the effects of a home care intervention programme on patients’ quality of life or on readmission time were included in the analyses.
Results: Only 9 prospective controlled studies were found; eight were performed in the United States and 1 in the United Kingdom. Their methodological quality was judged to be moderate (median rating 62 on a 100 point scale). None of the studies showed a negative influence of home care interventions on quality of life. A significantly positive influence on the outcome measures was seen in 2 out of the 5 studies measuring patients’ satisfaction with care, in 3/7 studies measuring physical dimensions of quality of life, in 1/6 studies measuring psychosocial dimensions, and in 2/5 studies measuring readmission time. The incorporation of team members’ visits to patients at home or regular multidisciplinary team meetings into the intervention programme seemed to be related to positive results.
Conclusions: The effectiveness of comprehensive home care programmes remains unclear. Given the enormity of the problems faced by society in caring for patients with terminal cancer, further research is urgently needed.
Key messages Only nine controlled prospective studies have compared the effects of home care intervention programmes for patients with terminal cancer with those of standard care, in relation to patients’ quality of life and time spent in hospital between start of care and death The methodological quality of these studies seemed to be moderate Home care programmes did not have a negative influence on quality of life or time spent in hospital; some studies observed positive effects on these outcome measures Enabling team members to visit patients at home and holding regular multidisciplinary team meetings seem important elements for obtaining favourable results The general belief that home care programmes are effective for patients with terminal cancer is not supported scientifically
PMCID: PMC28590  PMID: 9641929

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