title: Detected health and well-being problems following comprehensive geriatric assessment during a home visit among community-dwelling older people: who benefits most?
abstract: BACKGROUND
  Preventive home visits including comprehensive geriatric assessment for potentially frail older people are increasingly implemented in general practice. It remains unclear how to select older people who benefit most from it.
  
  
  OBJECTIVE
  To determine which community-dwelling older people benefit most from a comprehensive geriatric assessment by a practice nurse during a home visit in terms of detected problems.
  
  
  METHODS
  A cross-sectional study in 45 general practices in the Netherlands. Practice nurses visited 562 randomly selected older people (aged ≥ 75 years) and 1180 purposefully selected based on the following criteria: last visit to general practice >6 months ago; partner or child(ren) deceased within past 12 months; cognitive or psychosocial functioning unknown to GP; ≥2 chronic conditions; uses ≥5 medications and/or living alone.
  
  
  RESULTS
  Mean age of older people was 82.50 years, 65.50% was female. More problems were detected among women, higher age groups, those living alone and the less educated (all P < 0.001). Overall, more problems were detected in purposefully selected older people than in randomly selected older people (P < 0.001). Selection of older people with ≥2 chronic conditions and those using ≥5 medications resulted in more detected problems in general (both P < 0.05).
  
  
  CONCLUSIONS
  Although the findings are in favour of purposeful selection, observed differences in detected problems between the two selection procedures are relatively small. GPs should at least target older people with ≥2 chronic conditions, using ≥5 medications, being female, of an older age, living alone and the less educated.
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands, mandy.stijnen@maastrichtuniversity.nl.
authors.forename: Mandy M N
authors.initials: MM
authors.lastname: Stijnen
authors.affiliation: Primary Healthcare Organisation region 'Maastricht-Heuvelland' (ZIO), Maastricht, The Netherlands.
authors.forename: Maud S
authors.initials: MS
authors.lastname: Van Hoof
authors.affiliation: Primary Healthcare Organisation region 'Maastricht-Heuvelland' (ZIO), Maastricht, The Netherlands.
authors.forename: Ingeborg Y M
authors.initials: IY
authors.lastname: Wijnands-Hoekstra
authors.affiliation: Primary Healthcare Organisation region 'Oostelijk Zuid-Limburg/Parkstad' (HOZL), Heerlen, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Guldemond-Hecker
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands, Department of Patient and Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Inge G P
authors.initials: IG
authors.lastname: Duimel-Peeters
authors.affiliation: Tilburg School of Social and Behavioral Sciences, Scientific Centre for Care and Welfare (TRANZO), Tilburg University, Tilburg, The Netherlands, Saw Swee Hock School for Public Health, National University of Singapore, Singapore, Republic of Singapore.
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.affiliation: Academic Collaborative Centre for Public Health Limburg, Public Health Service Southern Limburg, Geleen, The Netherlands and Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: Maria W J
authors.initials: MW
authors.lastname: Jansen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis; D004522:Educational Status; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D034381:Hearing Loss / Q000175:diagnosis; D006792:House Calls; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D057187:Independent Living / Q000706:statistics & numerical data*; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis; D051346:Mobility Limitation; D009426:Netherlands; D050177:Overweight / Q000175:diagnosis; D018579:Patient Selection; D019338:Polypharmacy; D059017:Primary Care Nursing / Q000379:methods*; D012737:Sex Factors; D013851:Thinness / Q000175:diagnosis; D014549:Urinary Incontinence / Q000175:diagnosis; D014786:Vision Disorders / Q000175:diagnosis
keywords: Frail elderly; general practice; geriatric assessment; home visits; patient selection; primary health care.