METHODOLOGIC CHALLENGES OF RANDOMIZED CONTROLLED-STUDIES ON IN-HOME COMPREHENSIVE GERIATRIC ASSESSMENT - THE EIGER PROJECT

Previous controlled studies have shown that preventive home visits are a promising method for disability prevention in elderly per sons; how ever, due to the lack of data on cost effectiveness and optimal interv ention methods, there is still debate on their usefulness. Therefore, additional controlled studies must use new methods to resolve these un answered issues. We present a novel approach used in the project EIGER (Evaluation of In-Home Geriatric Health Visits in Elderly Residents), an ongoing randomized controlled trial of preventive home visits in c ommunity-residing persons aged 75 years and older in Bern, Switzerland . The intervention consists of in-home visits with structured comprehe nsive geriatric assessment and follow-up by specially trained nurses w ho collaborate with geriatricians and an interdisciplinary team. Speci al methods were used to optimize the sample size, to improve the healt h care cost analysis, to minimize and explore refusal to participate, to apply stratified randomization for subgroup analysis, and to evalua te the intervention process with a tracer method. Selected baseline fi ndings (N=791, mean age 82 years, 73% female) include uncontrolled sys tolic hypertension (54%), balance/gait disorder (9%), cognitive impair ment (7%), 6 or more medications (21%), depressive symptoms (10%), and impaired basic ADL (15%). Baseline findings demonstrate that this stu dy is likely to contribute to some of the unresolved issues of in-home prevention for older persons.