Early intervention in elderly clients ’ health problems identified by home helps

Objective: To study the effect of early intervention in health problems identified by home helps. Design: Open study with quasi-experimental design. Randomization took place at the level of the organizational units of home helps. Setting: Community health services and a hospital-based general practice. Subjects: Home help clients, 75 years or older, 113 in the intervention group and 161 in the compari-son group. Intervention: Home helps were trained to recognize signs of functional and mental impairment and asked to call the study doctor when new medical or functional problems were identified. The interven-tion lasted for two years with an additional year for observation. Main outcome measures: Causes of referral, ICD-9 diagnostic categories, time under surveillance before long-term care or death, use of community services and hospital beds. Results: 51 (45.1%) of the intervention subjects were referred once or more often, 110 referrals in all. General loss of function was the most frequent cause, and in all but six referrals specific diagnoses were made. Home helps ' referrals of patients with infection and stroke corresponded with the final diagnoses. After the first year of the study, the percentage of clients continuing to live at home was higher in the intervention group (P = 0.05 after adjustment for baseline differences in age and gender), mortality was similar, and use of hospital beds higher in the intervention group. Conclusions: Home helps can detect and communicate to a doctor functional decline and clinical manifestations of disease among their elderly clients. The study indicated, but provided no definite evidence, that direct referral from home helps to a hospital-based general practitioner can keep elderly people at home longer. Key words: Home help; elderly; case-finding; general loss of function; long-term care; randomized controlled tria