title: An in-home preventive assessment program for independent older adults: a randomized controlled trial.
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.
  
  
  METHODS
  Randomized controlled trial with 1-year follow-up.
  
  
  METHODS
  Home visits performed in a suburb of Los Angeles.
  
  
  METHODS
  Community-living veterans 70 years and older not currently receiving health care at the Sepulveda VA Medical Center (n = 131 intervention; 123 controls).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Geriatric Research, Education and Clinical Center (GRECC), Sepulveda Veterans Affairs Medical Center, CA 91343.
authors.forename: D
authors.initials: D
authors.lastname: Fabacher
authors.forename: K
authors.initials: K
authors.lastname: Josephson
authors.forename: F
authors.initials: F
authors.lastname: Pietruszka
authors.forename: K
authors.initials: K
authors.lastname: Linderborn
authors.forename: J E
authors.initials: JE
authors.lastname: Morley
authors.forename: L Z
authors.initials: LZ
authors.lastname: Rubenstein
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011314:Preventive Health Services / Q000458:organization & administration*; D014481:United States; D014728:Veterans; D014838:Volunteers