Clinical Yield from Preventive In-Home Comprehensive Geriatric Assessment Program Among Elderly People

Cho, Choo Yon; Hong, Sung Ho; Alessi, Cathy A

Abstract

OBJECTIVES
To evaluate the consequences of care of a program of preventive in-home comprehensive geriatric assessment(CGA) and determine: 1) if there are major findings in all domains of CGA(medical, functional, mental health and social/environmental), 2) if there is a continued clinical yield when CGA is repeated annually, and 3) factors which affect patient adherence with recommendations from CGA.
METHODS
Descriptive prospective study of subjects allocated to the intervention group of a randomized trial of preventive in-home CGA was applied to 202 persons aged 75 years or older and living at home who received the intervention of annual and quarterly home visits by gerontologic nurse practitioners(GNPs) for three years at participants' homes in an urban setting. Detailed data were collected prospectively on clinical problems detected by CGA, specific recommendations made of these problems, and subject adherence with these recommendations.
RESULTS
Participants were 80.8 years, 70% of them were female, 95% white, and 64% living alone.4 mean of 17.5 active problems per subject were identified in all domains of CGA, although the most common problems were medical.4 constant number of therapeutic and preventive recommendations was made each year(8.5 per subject annually). Subject adherence varied by type of recommendation(ANOVA, p=.0001); adherence was better for referrals to a physician than for referrals to a non-physician professional or community service or for recommendations involving self-care activities.
CONCLUSION
In these community-dwelling older people, there was a continued yield of problems identified and recommendations made when preventive in-home CGA was repeated annually for three years, supporting the practice of repeat CGA in community elders. Subject adherence with recommendations from CGA varied by type of recommendation, but further work is needed to determine additional factors which affect this adherence and to determine the association, if any, between the yield of CGA(i.e., problems identified and recommendations given) and important clinical consequences.