Perceived functional health of frail elderly in a primary home care programme and correlation of self-perception with objective measurements

This study examined the effects of a primary home care intervention programme on self-assessed functional health, and the correlation of self-perception with objective measures in frail elderly subjects. Elderly patients about to be discharged from an acute hospital, at risk for institutionalization, were randomly assigned to physician-led primary home care or to standard care. After early post-hospital in-home intervention and assessment, ongoing medical care and treatment were monitored by a multidisciplinary team. Functional data were collected at baseline and after six months. Self-rated and objectively rated functional variables included medical factors, personal and instrumental activities of daily living, ambulation, and social activities and contacts. From study entry to follow-up, the scores for personal activities of daily living were significantly increased in team and control subjects as were social contacts in the team subjects (P = 0.03). No differences between team and control groups were found for self-rated functions from study entry to follow-up, except for a tentatively statistical significance in self-rated physical health in favour of the team subjects. Positive correlations were recorded between all self-rated and objectively rated functions, but they were stronger at follow-up. Physical health and social contacts were over-rated, whereas indoor ambulation and social activities were underrated compared to objective measures at follow-up. Personal activities of daily living, were overrated at study entry, but showed substantial agreement at follow-up (0.62). Within demographic subgroups patients over 80 showed a stronger correlation between self-rated and objectively measured social functions after six months than younger patients. Men and women underrated ambulation compared to objective measures at follow-up. Women under-estimated their social activities compared to objective scor-ing at follow-up, whereas men showed a fair correlation. Personal activities of daily living at follow-up remained unchanged within demographic subgroups. The correlations between self-rated and objectively measured functions were not as definite as expected. Overrated physical health and social contacts, and underrated indoor ambulation and social activities probably provided a more realistic description of the patients' functions than the objective measurements could reveal. The outcomes indicate that self-rating of functions provides a valid measure of f