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Multidimensional Home Visit Programs: Helping Seniors Age in Place

An important element of healthy aging is aging in place — seniors remaining at home and active in their communities rather than moving into long-term care. When seniors are able to stay at home and continue to engage in their local communities, mortality rates are reduced, the stress on health care systems and operating budgets is eased and nursing home admissions are lowered. For aging in place to be maximally effective, multidimensional preventative home-visit programs (MPHVPs) focusing on multidisciplinary assessment, diagnostics and intervention targeted to keeping seniors at home are essential.

MVHVPs are multidisciplinary teams who assess seniors in their homes; they design and implement an individualized care plan based on biological, psychological and social determinants of health.

The overarching goals of MPHVPs include improving functionality and reducing morbidity and caregiver burden, while avoiding unnecessary visits to emergency departments and delaying long-term care placements. Home-based prevention techniques can take many forms: primary interventions include reducing clutter and making sure necessities are within easy reach, and secondary measures include things like communication aids and medication review to reduce potentially harmful drug interactions.

In an article published by the Canadian Geriatrics Society, Drs. Phil St. John and Kristina Swain say that the best candidates for MPHVPs are seniors between the ages of 65 and 80, who may be in the early stages of illness but still have lower overall mortality risk. Frail seniors who are highly dependent but exhibit low rates of functional decline are also prime contenders for home-based outreach.

MPHVPs generally operate close to other community-based services, with assessments being done in the patient’s home by one or two team members and the patient’s family/support system. Primary and home care providers review things like clinical exams, cognitive and functional status, medications, mood, diet and social and community supports.

St. John and Swain refer to successful MPHVPs as a “cog in the wheel” of a geriatric care network, with open communication between members of the home-visit team, primary care providers, the patient and their family. Programs should connect with a broad network, to allow for members of the greater community to be referred to inpatient and outpatient services. Strong administration is necessary to support both the MPHVP teams and the wider geriatric community.

The process of helping a senior to age successfully is more complex and multifaceted than simply maximizing their lifespan. Successful aging encompasses more than the physical; it includes social engagement, psychological well-being and personal support from immediate family, extended family and friends. MPHVPs are a relatively new development in the geriatric outreach field and have yet to be extensively studied. However, Drs. St. John and Swain indicate that findings to date show that multidimensional home visit programs are having a positive effect on all elements of successful aging and contribute to lowering health care operating costs by reducing unnecessary admissions.