Volume 53, Issue 4 p. 563-568

Feasible Model for Prevention of Functional Decline in Older People: Municipality-Randomized, Controlled Trial

Mikkel Vass MD

Mikkel Vass MD

From the * Department of General Practice and Central Research Unit for General Practice, and Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark Department of Economics, University of Southern Denmark, Odense, Denmark

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Kirsten Avlund DMed Sci

Kirsten Avlund DMed Sci

From the * Department of General Practice and Central Research Unit for General Practice, and Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark Department of Economics, University of Southern Denmark, Odense, Denmark

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Jørgen Lauridsen PhD

Jørgen Lauridsen PhD

From the * Department of General Practice and Central Research Unit for General Practice, and Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark Department of Economics, University of Southern Denmark, Odense, Denmark

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Carsten Hendriksen DMed Sci

Carsten Hendriksen DMed Sci

From the * Department of General Practice and Central Research Unit for General Practice, and Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark Department of Economics, University of Southern Denmark, Odense, Denmark

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First published: 30 March 2005
Citations: 70
Address correspondence to M. Vass, MD, Institute of Public Health, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark. E-mail: [email protected]

This study was supported by grants from the Danish Ministry of Social Affairs, the Danish Medical Research Council, the Research Foundation for General Practice and Primary Care, the Eastern Danish Research Forum, and the County Value-Added Tax Foundation.

Abstract

Objectives: To investigate the effect of an educational program for preventive healthcare professionals in routine primary care on functional ability, nursing home admissions, and mortality in older adults.

Design: A prospective, controlled 3-year follow-up study (1999–2001) in primary care with randomization and intervention at the municipality level and outcomes measured at the individual level in two age cohorts.

Setting: Primary care.

Participants: Of 81 eligible municipalities in four counties, 34 agreed to participate. A total study population of 5,788 home-dwelling subjects aged 75 and 80 were asked to participate. Written consent was obtained from 4,060 persons (70.1%), of whom 2,104 were living in 17 intervention municipalities and 1,956 were living in 17 matched control municipalities.

Intervention: Intervention municipality visitors received ongoing education, and local general practitioners were introduced to a short geriatric assessment program early in the study period. Control municipalities visitors and general practitioners received no education.

Measurements: At the 3-year follow-up, the outcome measures of mortality and nursing home admissions were obtained from all, and the outcome measure of functional ability was obtained from 3,383 (95.6%) of 3,540 surviving participants.

Results: Education improved functional ability (odds ratio=1.20, 95% confidence interval (CI)=1.01–1.42, P=.04) in intervention municipality participants, notably in the 80-year-olds. There were no differences in mortality (relative risk (RR)=1.06, 95% CI=0.87–1.28, P=.59) or rates of nursing home admissions after 3 years (RR=0.74, 95% CI=0.50–1.09, P=.13). Subjects aged 80 benefited from accepting and receiving in-home assessment with regular follow-ups.

Conclusion: A brief, feasible educational program for primary care professionals helps preserve older people's functional ability.