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.

Objectives: 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).

Conclusion: 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.

Keywords: Frail elderly; general practice; geriatric assessment; home visits; patient selection; primary health care..