A preventive program for community-dwelling elderly at risk of functional decline: a pilot study

A program has been designed to assess and survey community-dwelling elderly over 75, identified at risk of functional decline by a postal questionnaire. The objectives were to verify the acceptability and the feasability of the program and to explore its impact, mainly on the functional status. A randomized controlled study took place in an urban community where 99 participants were drawn from those having responded positively to two or more of the six questions asked in the postal questionnaire, previously studied in Sherbrooke, in 1992. The program consisted in a home visit by a nurse who administered a standardized assessment battery on risk factors identified specifically for functional decline. When problems were identified, experimental subjects were referred to their general practitioner or to other health professionals for diagnosis and interventions. The control subjects received the usual health services. Both process and outcome measures were utilized in the study. The process measures allowed to know whether the program was acceptable or not to subjects and if it was feasible when using the existing health care services. The outcome measures included the number of eliminated risk factors, the functional autonomy level, the general well-being, the perceived state of health and the social support. The results showed that the program was feasible to implement and acceptable by the subjects and by health professionals. After 6 months, study subjects did not loose autonomy whereas the control ones significantly declined (P<0.001). If preventive programs could be effective in reducing the loss of autonomy, the use and cost of health care services could also be reduced and the other health and wellfare problems could be also prevented.