An educational programme for primary healthcare providers improved functional ability in older people living in the community

摘要

The study by Vass et al makes an important contribution to our knowledge of the effectiveness of preventive home visits in delaying or preventing functional impairment in elderly people. The study was well designed and had an adequate sample size. It should be noted that the study was done in Denmark, where all citizens >=75 years of age are offered 2 annual preventive home visits. Visiting professionals in the intervention group received instruction on the use and interpretation of a standardised tool for assessing functional ability. The authors did not describe the content of the usual (control) preventive visits, but one would expect healthcare professionals to assess functional decline and offer guidance and support during routine health checks in people s-75 years of age. If this were the case, it would tend to mask the benefits of the intervention. Vass ef al found that the intervention was more beneficial for participants who were 80 years of age than for those who were 75 years of age. They also recommend focusing on the early triggers of functional decline when function is more modifiable. In contrast, a systematic review by Stuck et al concluded that mortality risk was modifiable in people <80 years of age but not in those ;s80 years of age,, although much of the evidence in this review came from countries without routine preventive home visits. Only 60% of people s-75 years of age accepted and received the core preventive home visits. Further research is required to determine why 40% of people refused this service because even the most beneficial intervention will have no effect if it is refused. In most countries, preventive programmes are not routinely offered to elderly people. The study by Vass ef al supports the use of programmes that include an assessment of functional decline and additional focused education for healthcare professionals working with older people.