title: The value of specialist clinical assessment of older people prior to entry to care homes.
abstract: OBJECTIVE
  to ascertain the value of employing a specialist clinician's contribution to the assessment of older people prior to care home entry.
  
  
  METHODS
  randomised controlled trial.
  
  
  METHODS
  256 older people at risk of care home entry were randomly allocated to either a control group, who received the usual care management assessment, or to an experimental group who, in addition, received a clinical assessment by a geriatrician or old age psychiatrist. The value of the additional assessment was evaluated by an analysis of clinical recommendations, questionnaires eliciting the views of stakeholders and research interviews with older people and their carers at initial assessment and 6 months. Data on service use and costs over 6 months and on destination at 6 and 12 months were also collected.
  
  
  RESULTS
  the clinical assessment uncovered covert morbidity previously unknown to care managers particularly in respect of cognitive impairment and was adjudged acceptable to the different stakeholders involved. Those receiving the clinical assessment experienced less deterioration in their physical functioning, had less contact with nursing homes and emergency services and their carers experienced reduced levels of distress. Overall, the costs of care for those receiving the assessment were no greater with NHS costs actually lower.
  
  
  CONCLUSIONS
  the potential benefits in involving specialist clinicians in the assessment process include identifying previously undiagnosed conditions and enhancing care managers' decision making. Such an assessment could be provided at a modest marginal cost. The approach is fully compatible with proposals for the role of the community geriatrician and commensurate with current good clinical practice in old age psychiatry.
authors.affiliation: Personal Social Services Research Unit, Faculty of Medicine, Dentistry, Nursing and Pharmacy, Dover Street Building, University of Manchester, Manchester M13 9PL, UK. D.J.Challis@man.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Challis
authors.forename: Paul
authors.initials: P
authors.lastname: Clarkson
authors.forename: Janine
authors.initials: J
authors.lastname: Williamson
authors.forename: Jane
authors.initials: J
authors.lastname: Hughes
authors.forename: Dan
authors.initials: D
authors.lastname: Venables
authors.forename: Alistair
authors.initials: A
authors.lastname: Burns
authors.forename: Ashley
authors.initials: A
authors.lastname: Weinberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D015577:Geriatric Assessment / Q000379:methods*; D005853:Geriatrics; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D011570:Psychiatry; D006113:United Kingdom