Enabling health and maintaining independence for older people at home: the ‘HomeHealth’ Randomised Controlled Trial

Walters, K, Frost, R ORCID: 0000-0003-3523-0052, Barrado-Martín, Y, Kalwarowsky, S, Marston, L, Pan, S, Avgerinou, C, Goodman, C, Clegg, A, Gardner, B, Hopkins, J, Mahmood, F, Gould, RL, Elaswarapou, R, Jowett, C, Skelton, DA, Drennan, VM, Cooper, C, Kharicha, K, Logan, P et al (2026) Enabling health and maintaining independence for older people at home: the ‘HomeHealth’ Randomised Controlled Trial. Health Technology Assessment, 30 (43). pp. 1-22. ISSN 1366-5278

Preview

Text Enabling health and maintaining independence for older people at home.pdf - Published Version Available under License Creative Commons Attribution. Download (1MB) | Preview

Abstract

Background: HomeHealth is a home-based, voluntary sector service supporting older people with mild frailty to maintain independence through behaviour change. Support workers discuss the person’s priorities and enable setting/achieving goals around mobility, nutrition, socialising and/or psychological well-being. Aims: We tested clinical and cost-effectiveness of HomeHealth for maintaining independence in older people with mild frailty in a randomised controlled trial. Methods: Design: Single-blind, parallel randomised controlled trial open between 18 January 2021 and 4 July 2023, with mixed-methods process evaluation. Setting: Community-dwelling older people aged 65+ years with mild frailty from 27 general practices and community settings in London, Yorkshire and Hertfordshire. Randomisation: Participants were randomised 1: 1 to receive HomeHealth or treatment as usual. Outcomes: Primary outcome was independence in activities of daily living (modified Barthel Index), analysed using linear mixed models. Secondary outcomes included frailty phenotype score, extended activities of daily living, wellbeing, psychological distress, loneliness, cognition, falls and mortality. Health economic outcomes included quality of life, capability and service use, including hospital admissions. Cost-effectiveness acceptability curves and cost-effectiveness planes were used to represent the probability of cost-effectiveness compared to treatment as usual. Process evaluation: We conducted semistructured interviews with participants receiving the intervention, HomeHealth workers and other stakeholders supporting service delivery. Interviews were thematically analysed. Fidelity of audio-recorded appointments was assessed by two independent raters. We evaluated potential mechanisms of impact using data from appointments attended, types of goals set and progress towards goals. Findings: We recruited 388 participants, mean age 81.4 years (standard deviation 6.5), 64% female and 94% White British/European. HomeHealth did not improve Barthel Index scores at 12 months (0.250, 95% confidence interval −0.932 to 1.432). At 6 months, we found small significant reductions in psychological distress (−1.237, 95% confidence interval −2.127 to −0.348), and frailty phenotype score (−0.252, 95% confidence interval −0.487 to −0.017). At 12 months, we found significant improvements in well-being (1.449, 95% confidence interval 0.124 to 2.775), reduced unplanned admissions (incidence rate ratio 0.65, 95% confidence interval 0.54 to 0.92) with lower associated costs (−£586/participant, 95% confidence interval −351 to −821). There were no differences in other outcomes. HomeHealth dominates treatment as usual with a negative point estimate for incremental costs (−796, 95% confidence interval −2016 to 424), positive point estimate for incremental quality-adjusted life-years (0.009, −0.021 to 0.039) and high probability of cost-effectiveness. Process evaluation: Sixty-four semistructured interviews were completed, including 49 participants and 15 HomeHealth workers/stakeholders. The service was acceptable and safe, with good fidelity of delivery. Participants made progress on personalised goals, most working on enhancing mobility. They found the service empowering, and received emotional/practical support. Engagement was more challenging when participants identified no need for change, had significant memory impairment or new/declining illness. Flexibility around varying symptoms and incorporating behaviour change into existing routines promoted engagement. Conclusion: HomeHealth did not improve independent functioning for older people with mild frailty. There were small significant improvements in frailty status, psychological distress and well-being and a 35% reduction in unplanned admissions, with high probability of cost-effectiveness. Limitations: We used a pragmatic design with intervention delivery in real-world settings during/after the COVID-19 pandemic, potentially with more variability in delivery. Our findings might not apply to other geographical settings/ healthcare systems.

Item Type:	Article
Additional Information:	Copyright © 2026 author et al. This work was produced by author et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC-BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed. The text and layout of all journals published under the NIHR Journals Library are published under the Creative Commons Attribution (CC BY) licence.' Under this license, authors agree that anyone can reuse part or all of your article under the Creative Commons Attribution (CC BY) terms. This licence permits unrestricted use, distribution, reproduction and adaption in any medium and for any purpose provided that it is properly attributed. The proper attribution to NIHR Journals Library journals must include the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication
Uncontrolled Keywords:	Humans; Activities of Daily Living; Single-Blind Method; Quality of Life; Aged; Aged, 80 and over; Frail Elderly; Home Care Services; Cost-Benefit Analysis; Female; Male; Independent Living; Cost-Effectiveness Analysis; Aging in Place; HEALTH ECONOMIC EVALUATION; HEALTH PROMOTION; LATER LIFE; MILD FRAILTY; PREVENTION; PROCESS EVALUATION; RANDOMISED CONTROLLED TRIAL; WELL-BEING; Humans; Aged; Female; Cost-Benefit Analysis; Male; Single-Blind Method; Aged, 80 and over; Activities of Daily Living; Quality of Life; Cost-Effectiveness Analysis; Home Care Services; Frail Elderly; Independent Living; Aging in Place; 4203 Health Services and Systems; 4206 Public Health; 42 Health Sciences; Dissemination and Implementation Research; Cost Effectiveness Research; Comparative Effectiveness Research; Health Services; Behavioral and Social Science; Aging; Clinical Research; Clinical Trials and Supportive Activities; 7.1 Individual care needs; Generic health relevance; 3 Good Health and Well Being; Humans; Aged; Female; Cost-Benefit Analysis; Male; Single-Blind Method; Aged, 80 and over; Activities of Daily Living; Quality of Life; Cost-Effectiveness Analysis; Home Care Services; Frail Elderly; Independent Living; Aging in Place; 0806 Information Systems; 0807 Library and Information Studies; 1117 Public Health and Health Services; Health Policy & Services; 4203 Health services and systems; 4206 Public health
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RT Nursing
Divisions:	Nursing, Public and Allied Health
Publisher:	National Institute for Health and Care Research
Date of acceptance:	1 February 2026
Date of first compliant Open Access:	2 September 2026
Date Deposited:	02 Sep 2026 14:34
Last Modified:	02 Sep 2026 14:34
DOI or ID number:	10.3310/GJKW1909
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29304

View Item