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Objective : To evaluate the effectiveness of in‐home geriatric assessments as a means of providing preventive health care and improving health and functional status of community‐living elderly veterans. Design : Randomized controlled trial with 1‐year follow‐up. Setting : Home visits performed in a suburb of Los Angeles. Participants : Community‐living veterans 70 years and older not currently receiving health care at the Sepulveda VA Medical Center ( n = 131 intervention; 123 controls). Intervention : A home visit by a physician's assistant or nurse, to screen for medical, functional and psychosocial problems, followed by a letter describing findings and recommendations, and follow‐up visits by trained volunteers at 4‐month intervals for 1 year. Controls received only telephone interviews at 4‐month intervals to collect outcome data. Measurements : Compliance with recommendations was studied for the intervention group. Outcome comparisons between the two groups included: mortality, medication usage, functional status, immunization rates, and nursing home and hospital utilization. Main Results : A mean of four new or suboptimally treated problems was identified for intervention subjects. Subjects complied with 76% of recommendations to see a physician or initiate a specific health practice. At 12‐month follow‐up, intervention subjects had significantly increased their immunization rates ( P < 0.001) and had a significantly increased likelihood of having a primary care physician ( P < 0.05). Twelve‐month functional status (IADL) scores were significantly higher for intervention subjects than for controls; intervention subjects maintained their functional status, while controls experienced significant decline during the follow‐up year ( P < 0.05). Non‐prescription drug use increased significantly among controls, but not among intervention subjects ( P < 0.05). Conclusions : A brief geriatric screening assessment performed in the home can detect unrecognized and treatable problems, even among relatively healthy older adults. The use of trained volunteers is a feasible strategy for providing health education and follow‐up contacts. These results support the concept that preventive gerontological approaches can help maintain important aspects of health and function.
Fabacher et al. (1994) studied this question.