A TRIAL OF ANNUAL IN-HOME COMPREHENSIVE GERIATRIC ASSESSMENTS FOR ELDERLY PEOPLE LIVING IN THE COMMUNITY

Background and Methods. The prevention of disability in elderly people poses a challenge for health care and social services. We conducted a three-year, randomized, controlled trial of the effect of annual in- home comprehensive geriatric assessments and follow- up for people living in the community who were 75 years of age or older. The 215 people in the intervention group were seen at home by gerontologic nurse practitioners who, in collaboration with geriatricians, evaluated prob- lems and risk factors for disability, gave specific recom- mendations, and provided health education. The 199 people in the control group received their regular medical care. The main outcome measures were the prevention of disability, defined as the need for assistance in per- forming the basic activities of daily living (bathing, dress- ing, feeding, grooming, transferring from bed to chair, and moving around inside the house) or the instrumental ac- tivities of daily living (e.g., cooking, handling finances and medication, housekeeping, and shopping), and the pre- vention of nursing home admissions. Results. At three years, 20 people in the intervention group (12 percent of 170 surviving participants) and 32 in the control group (22 percent of 147 surviving partici- pants) required assistance in performing the basic activ- ities of daily living (adjusted odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.8; P � 0.02). The number of persons who were dependent on assistance in perform- ing the instrumental activities of daily living but not the basic activities did not differ significantly between the two groups. Nine people in the intervention group (4 percent) and 20 in the control group (10 percent) were permanent- ly admitted to nursing homes (P � 0.02). Acute care hos- pital admissions and short-term nursing home admis- sions did not differ significantly between the two groups. In the second and third years of the study, there were sig- nificantly more visits to physicians among the partici- pants in the intervention group than among those in the control group (mean number of visits per month, 1.41 in year 2 and 1.27 in year 3 in the intervention group, as compared with 1.11 and 0.92 visits, respectively, in the control group; P � 0.007 and P � 0.001, respectively). The cost of the intervention for each year of disability- free life gained was about $6,000. Conclusions. A program of in-home comprehensive geriatric assessments can delay the development of dis- ability and reduce permanent nursing home stays among elderly people living at home. (N Engl J Med 1995;333: 1184-9.)