Use of comprehensive home care assessment tools for community-dwelling older adults to improve adherence, quality of life, and health outcomes: A systematic review and meta-analysis

Abstract

Comprehensive homecare assessment has been determined to be essential in the context of care management for community-dwelling older adults. However, the effectiveness of assessment tools for adherence and health outcomes is yet to be fully elucidated. Thus, in this systematic review, we aim to evaluate the effects of comprehensive homecare assessment tools on adherence and other health outcomes among community-dwelling older adults. Database searches were performed using CINAHL Plus with full text, PubMed, EMBASE, CENTRAL, and Ichushi. Randomized controlled trials search were conducted until September 2020. Studies comparing interventions using comprehensive homecare assessment tools were assessed using the Cochrane's risk of bias 2 for quality; in randomized trials, a meta-analysis was performed. Nine articles, including eight studies, were included in this review. All interventions involved comprehensive homecare assessment tools such as CGA, SEISAR, RAI-HC, TARGET combined with interRAI-HC, MDS-HC, and the Omaha system. As per the results of the meta-analysis, no difference was observed with regard to adherence (p =.11), hospital admission (p =.29), nursing home admission (p =.70), and mortality (p =.96) compared with the non-use of the assessment tools. The mental quality of life showed a significant effect in the comprehensive assessment group (standardized mean difference = 0.26; 95% confidence interval = 0.06 to 0.46; p =.01); however, certainty of the evidence (GRADE) was assessed to be moderate. Comprehensive homecare assessment tools may be particularly useful for enhancing the psychological quality of life beyond a comprehensive assessment. This review presents insufficient evidence to support adherence to homecare and the enhancement of other health outcomes for community-dwelling older adults.