Since 1998, all Danish municipalities have been required by law to offer the preventive home visit (PHV) to all citizens aged 75 and older.
Danish health care is financed by the public sector, and municipalities deliver various services to older citizens under legislation established by the central government.
Why the PHV?
The PHV model promotes overall health and well being in old age. According to the legislation, PHV aims to help older people care for themselves using their own resources.
Home visits are usually carried out by trained nurses who offer advice and support on health and social issues. They do not diagnose, prescribe medication or refer older adults to specialist doctors.
The PHV model is based on the practice of care as negotiation. This means that home visits are by invitation and offered twice a year. Older citizens who accept them choose what they want to share with the health-promotion staff.
About 80 per cent of all Danish seniors regularly participate in the program.
Care as negotiation
New research by Lene Otto and colleagues (published online in the International Journal of Ageing and Later Life: Vol. 8, No.1, 2013), looked at what happens during the home visits.
Typically, older persons served coffee to the health advisor and provided a short update on their lives. These updates included various health topics, such as the status of a diabetes regulation or a prostate problem. They also talked about social factors, such as family, friendships or financial situations.
Health advisors stressed the importance of physical exercise. They highlighted research that shows functional ability can be improved even at very old ages. According to the author, "The key word here is improve: the idea is that aging is not a process of decline, but instead it is a process of potential development and growth."
The meetings between the health visitor and the older person involved open-ended conversations about health experiences.
Take, for example, 99-year-old Mrs. Nielsen. Mrs. Nielsen enjoyed her weekly walks in the neighbourhood with a group of old citizens arranged by the municipal health department. But because she is almost blind she was troubled by the many traffic lights which were difficult for her to interpret. Her daughter wanted her to give up her walks.
The health advisor and Mrs. Nielsen devised a detailed process of negotiating Mrs. Nielsen’s route, so she would be able to continue her walks. This included which crossings to avoid, when to stay behind and how to exercise on her own until the rest of the walking group returns on the route.
There was also 81-year-old Mr. Thomsen, who had not left his apartment for more than a month due to a lot of snow and ice in the streets. When the health advisor and Mr. Thomsen discussed his exercise program, Mr. Thomsen said he was bored riding his exercise bicycle in the living room without getting anywhere.
He wanted to resume his daily walks in the city. To encourage him to do that, the health advisor pointed out a nearby store that carries special non-slip soles he could use on his shoes. She arranged for neighbours to buy them for him.
Researchers noted the practice of care as negotiation was well established among the health advisors: "They seem to take on a more active role, not only informing of and coordinating medical services, but tracking care solutions that are attuned with the old citizens’ individual daily lives."
Occasionally, the negotiations were unsuccessful. Take Mr. Holten, 78, who preferred to sit in his chair leaving his wife to do all the housework and all the driving. When the health advisor urged Mr. Holten to increase his level of activity and go for a daily walk, he had none of it. "I’m fine as it is!" he said.
Impact of the PHV
Over the past decade, public health studies showed home visits:
- have led to raising 80-year-olds’ functional levels
- have led to fewer nursing-home days
- have led to fewer falling accidents, and
- have delayed the need to move an older person into a nursing home.
In sum, the program has proven to be an effective tool for helping adults over 80 maintain their functional ability and remain in their own homes as long as possible.
In recent years, older adults have also become more physically active.
A 2007 study showed people in their 70s were just as active as people in their 20s. The study also revealed 62 per cent of adults aged 60 to 69 exercised more that any other adult age group.
The study concluded the PHV model is a successful example of health promotion. PVH taught older citizens to recognize activity as closely linked to their future well-being and longevity.
The program stressed prevention as a primary value, and it promotes skills of self-care and self-awareness to help older adults enjoy life.
More broadly, the home visit scheme gave municipal health authorities rare insight into the lives of older citizens, enabling them to better plan for the needs of the older population.