[A screening and comprehensive assessment programme aimed at secondary prevention of disability in community-dwelling frail older subjects: a pilot study].

OBJECTIVE: to test a screening and comprehensive assessment procedures for frail elderly in Tuscany (Central Italy) in the perspective of interventions to prevent disability.

DESIGN: two-phases feasibility study: a) screening phase, using a postal questionnaire and b) comprehensive assessment phase, aimed at identifying risk factors for disability that might be targeted by specific interventions.

SETTING AND PARTICIPANTS: 11,589 individuals aged over 70, living at home, identified from residents registry of 2 health care districts in Tuscany, excluding subjects with recognized disability and those living in nursing home. Participants were sent a 7-item postal questionnaire (modified Sherbrooke Postal Questionnaire). Respondents with a score =3, suggestive of frailty, were offered an in-home comprehensive assessment performed by a nurse or social worker, oriented to ascertain independence in activities of daily living, lower limbs extremity function, mood status, malnutrition risk, cognitive level, visual acuity, hearing function, environmental risk and medications number. General practitioners, social workers or specific health care services were thereafter informed about results of the assessment with recommendations for specific interventions.

RESULTS: among 6,629 respondents to the questionnaire, 52% (No. 3,432) scored =3, triggering the comprehensive assessment, which was performed in 66% of cases (No. 2,276). Out of them, 38% showed already a disability in basic activities of daily living. Of the remaining 1,411, 38% showed a disability in instrumental activities of daily living, 30% a reduced lower limb extremity function, 18% depressive symptoms, and 11% a cognitive impairment. Human resources used for the project were limited in relation to the extent of the involved population.

CONCLUSIONS: postal screening of frailty in older subjects is feasible and is able to identify patients who might benefit from further assessment to address interventions for specific risk factors.