An In‐Home Preventive Assessment Program for Independent Older Adults: A Randomized Controlled Trial

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Abstract
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.