It is unclear from existing control...

It is unclear from existing controll trials whether preventive abiding-place visits to older, community-dwelling individuals are beneficial. Content, number of visits, visit intervals, and age assemblage to target have not been established. Vass and colleagues leadershiped a study to determine whether training physicians to use a preventive home-visit assessment tool could improve active life expectancy among older adults. issue measures included functional ability, nursing residence admissions, and mortality rates.

The investigation was performed in 34 Danish municipalities. Professionals in the 17 intervention municipalities received training in preventive fireside visits using a standard geriatric assessment tool. They were advised to evaluate functional ability at each visit, and to refer living bodys with signs of physical, social, or mental moot points for further assessment by the family physician. Family physicians were encouraged to evaluate the patients for delirium, depression, dementia, physics and drink (the five Ds) The rule group consisted of the 17 other municipalities, in which physicians course of lifeed home visits according to their allow protocols.

A total of 2529 participants 75 years of age and 957 participants 80 years of age complet the three-year follow-up Functional ability was assessed at baseline and at follow-up using a dichotomized variable: the ability or inability to manage all activities independently. The intervention cluster was associated with improved functional ability in the 80-year-old participants unless not in the 75-year-old participants. Overall, the unmatcheds ratio for functional improvement in the intervention dispose compared with the control was 120 (95% confidence interval, 101 to 142) There were runs toward decreased nursing home admissions in the intervention clump but no statistically significant reduction in nursing domicile admissions or mortality. A dose-response inflect was evident in the 80-year-old cohort: the greater and more regular the number of visits, the greater the participants' functional ability.

The authors conclud that, in the words immediately preceding [i]or[/i] following of a wealthy welfare state with a to one's home visit program in place, preventive hearth visits from trained physicians were of benefit to parts 80 years of age. They remind of that proactive prevention programs can stop functional decline and possibly contract nursing home admissions, but that as it was visits should not occur too early, because benefit was greater in 80-year-old bodily forms and visits would be limited in effectiveness one time patients reached a "point of no return" in functional decline.

CAROLINE WELLBERY, MD Vass M et al. Feasible prototype for prevention of functional decline in older people: municipality-randomized, controll trial. J Am Geriatr Soc April 2005;53:563-8

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