Home-based comprehensive assessment of rural elderly persons: the CARE project

Area of Science:

• Gerontology
• Rural Health
• Healthcare Delivery Models

Background:

• Home-based comprehensive geriatric assessment (CGA) is proven effective in urban settings but understudied in rural areas.
• CGA is a holistic evaluation including medical, functional, cognitive, and social aspects.
• Adapting urban CGA models to rural settings requires specific investigation.

Purpose of the Study:

• To develop and pilot a rural home-based CGA model.
• To assess the adaptability of successful urban CGA models to rural environments.
• To identify necessary modifications for rural home-based CGA.

Main Methods:

• A developmental demonstration project utilizing qualitative and quantitative evaluations.
• A home health agency and remote geriatrician collaborated via teleconference.
• Elderly volunteers (N=51, aged 75+) participated; survey instruments and focus groups were used.

Main Results:

• High prevalence of Instrumental Activities of Daily Living dependency and gait/balance issues found.
• An average of 1.1 major and 4.9 nonmajor problems identified per patient.
• Recommendations were implemented for 32% of major and 35% of nonmajor problems; positive outcomes included increased clinic visits and initiation of services.

Conclusions:

• Home-based CGA effectively identifies critical health problems in rural older adults.
• The current model requires further modifications for optimal effectiveness in rural settings.
• Successful adaptations included initiating regular clinic visits, vision services, physical therapy, and social work interventions.