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.

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Many children arrive at school with problems of development and behaviour which affect their educational achievement and social interaction and can have lifelong consequences. There is a strong association between developmental vulnerability at school entry and a well-documented series of parent and family risk factors, often linked to social disadvantage. Strategies which are likely to make a difference to these children and improve outcomes include family support, high-quality early education and care programmes in the preschool years, and early detection of emerging problems and risk factors. The evidence suggests that these services and programmes are best delivered within a framework of progressive universalism--a universal basket of services for all children and families, with additional support commensurate with additional needs. This provides the best opportunity for early identification and appropriate intervention for emerging developmental problems and family issues that impact on children's development. While there are a number of challenges that need to be addressed and overcome, such an approach is an important investment that will yield measurable educational, social and economic benefits over the long term.