IDENTIFICATION AND ASSESSMENT OF HIGH-RISK SENIORS

Context: Many older adults with chronic illnesses and multidimensional needs are at high risk of adverse health outcomes, poor quality of li fe, and heavy use of health-related services. Modern proactive care of older populations includes identification of such highrisk individual s, assessment of their health-related needs, and interventions designe d both to meet those needs and to prevent undesirable outcomes. Object ive: This paper outlines an approach to the tasks of identifying and a ssessing high-risk seniors. Intervention identification of high-risk s eniors (also called case finding) is accomplished through a,combinatio n of periodic screening, recognition of high-risk seniors by clinician s, and analysis of administrative databases. Once identified, potentia lly high-risk individuals undergo an initial assessment in eight domai ns: cognition, medical conditions, medications, access to care, functi onal status, social situation, nutrition, and emotional status. The in itial assessment is accomplished in a 30- to 45-minute interview condu cted by a skilled professional-usually one with a background in nursin g. The data are used to link some high-risk persons with appropriate s ervices and to identify others who require more detailed assessments. Detailed assessment is often performed by interdisciplinary teams of v arious compositions and methods of operation, depending on local circu mstances. Conclusion: The rapid growth in Medicare managed care is pre senting many opportunities for developing more effective strategies fo r the proactive care for older populations. Identification and assessm ent of high-risk individuals are important initial steps in this proce ss, paving the way for testing of interventions designed to reduce adv erse health consequences and to improve the quality of life.