A TRIAL OF ANNUAL IN-HOME COMPREHENSIVE GERIATRIC ASSESSMENTS FOR ELDERLY PEOPLE LIVING IN THE COMMUNITY

Background and Methods. The prevention of disability in elderly people poses a challenge for health care and social services. We conducted a three-year, randomized, controlled trial of the effect of annual in-h ome comprehensive geriatric assessments and followup for people living in the community who were 75 years of age or older. The 215 people in the intervention group were seen at home by gerontologic nurse practi tioners who, in collaboration with geriatricians, evaluated problems a nd risk factors for disability, gave specific recommendations, and pro vided health education. The 199 people in the control group received t heir regular medical care. The main outcome measures were the preventi on of disability, defined as the need for assistance in performing the basic activities of daily living (bathing, dressing, feeding, groomin g, transferring from bed to chair, and moving around inside the house) or the instrumental activities of daily living (e.g., cooking, handli ng finances and medication, housekeeping, and shopping), and the preve ntion of nursing home admissions. Results. At three years, 20 people i n the intervention group (12 percent of 170 surviving participants) an d 32 in the control group (22 percent of 147 surviving participants) r equired assistance in performing the basic activities of daily living (adjusted odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.8; P = 0.02). The number of persons who were dependent on assistance in performing the instrumental activities of daily living but not the bas ic activities did not differ significantly between the two groups. Nin e people in the intervention group (4 percent) and 20 in the control g roup (10 percent) were permanently admitted to nursing homes (P = 0.02 ). Acute care hospital admissions and short-term nursing home admissio ns did not differ significantly between the two groups. In the second and third years of the study, there were significantly more visits to physicians among the participants in the intervention group than among those in the control group (mean number of visits per month, 1.41 in year 2 and 1.27 in year 3 in the intervention group, as compared with 1.11 and 0.92 visits, respectively, in the control group P = 0.007 and P = 0.001, respectively). The cost of the intervention for each year of disability-free life gained was about $6,000. Conclusions. A progra m of in-home comprehensive geriatric assessments can delay the develop ment of disability and reduce permanent nursing home stays among elder ly people living at home.