Rubenstein L Z, Aronow H U, Schloe M, Steiner A, Alessi C A, Yuhas K E, Gold M, Kemp M, Raube K, Nisenbaum R
UCLA School of Medicine, Multicampus Program of Geriatric Medicine and Gerontology.
Aging (Milano). 1994 Apr;6(2):105-20. doi: 10.1007/BF03324224.
Controlled trials in a number of countries have documented benefits from different types of in-home assessment and treatment programs for various subgroups of elderly persons. We have developed a program to test, using a randomized controlled design, the concepts of in-home comprehensive geriatric assessment (CGA) coupled with follow-up, health education, and preventive care in an urban United States community. The intervention includes yearly in-home CGA by geriatric nurse practitioners (GNPs), who provide, following discussions with physician geriatricians, lists of specific recommendations for health and well-being enhancement. The GNPs provide follow-up visits quarterly and regular telephone contacts to improve compliance. We recruited for our trial 414 home-living subjects aged 75 years and over, 215 randomized to the intervention group and 199 to the control group. Subjects were generally representative of the overall elderly population of the city of Santa Monica, a seaside suburb of Los Angeles. Extensive baseline data (medical, functional, psychosocial and environmental) were collected from subjects prior to randomization, using validated instruments whenever possible. Follow-up data were collected from each subject every 4 months by trained research assistants throughout the 3-year intervention follow-up period. Our study was designed to assess effects of the intervention on the hypothesized outcomes of health status, functional status, psychosocial parameters, and service utilization. Careful documentation of the intervention will enhance our ability to make process-outcome comparisons. Preliminary analysis reveals that the in-home CGA uncovered many important health deficits for most subjects resulting in a number of substantial recommendations. We are confident that when it is completed, this study will succeed in answering important remaining questions about the feasibility and effectiveness of establishing a geriatric in-home prevention and health promotion program in the United States based on principles of CGA.
一些国家进行的对照试验记录了针对不同老年亚群体的各类居家评估和治疗项目所带来的益处。我们开发了一个项目，采用随机对照设计，在美国城市社区测试居家综合老年评估（CGA）的概念，并结合后续跟进、健康教育和预防保健。干预措施包括由老年护理从业者（GNP）每年进行一次居家CGA，他们在与老年科医生讨论后，提供一系列关于增进健康和福祉的具体建议清单。GNP每季度进行随访，并定期电话联系以提高依从性。我们为试验招募了414名75岁及以上的居家生活受试者，其中215名随机分配到干预组，199名分配到对照组。受试者总体上代表了洛杉矶海滨郊区圣莫尼卡市的老年人口。在随机分组前，尽可能使用经过验证的工具从受试者那里收集了广泛的基线数据（医学、功能、心理社会和环境方面）。在为期3年的干预随访期内，由经过培训的研究助理每4个月从每个受试者收集一次随访数据。我们的研究旨在评估干预措施对健康状况、功能状态、心理社会参数和服务利用等假设结果的影响。对干预措施的详细记录将增强我们进行过程与结果比较的能力。初步分析表明，居家CGA发现大多数受试者存在许多重要的健康缺陷，从而产生了许多实质性建议。我们相信，这项研究完成后，将成功回答关于在美国基于CGA原则建立老年居家预防和健康促进项目的可行性和有效性方面仍存在的重要问题。
