The hypothesis which drives this study can be stated as follows: Interventions designed to enhance understanding of disease processes in the elderly population will allow the patient to become an active participant in preventive strategies in a primary, secondary and tertiary level would improve health related outcomes in the population served In our University Hospital. In a cost conscious environment, models which are geared to recenter the responsibility of health promotion and disease prevention to the patient are more likely to succeed.The elderly population in the United States represents 13% of the population and in the year 2030 will account for 23%. This geriatric population will require a progressive larger amount of health care dollars in order to maintain current levels of care. Current models for Comprehensive Geriatric care have not been successfully implemented in the majority of community and University Hospitals due to the cost and fiscal responsibilities the institutions would need to assume in a scenario of inadequate reimbursement and decreased fiscal resources. These issues are particularly relevant in institutions that predominantly serve minority populations. The nature of health care encounters of the geriatric population in our institution has been analyzed. Geriatric patients represent 44-48% of the admissions to the department of medicine. They frequently express some degree of significant physical disability. Their perception of disease process is not appropriate in many instances and cost-effective preventive strategies are not followed. The special social vulnerability of this population is well documented. In spite of multiple areas amenable to preventive geriatrics a number of barriers exist which do not allow optimal implementation. The ASSUME project aims to develop a model of direct intervention with geriatric patients via a Case Care Manager designed to increase self-care activities by developing a wider and more focused patient involvement in his/her health care decisions. This pilot study will be done in a randomized fashion and will be tied to the evaluation of multiple outcome assessments in a 4 year period. This study could lead to the development of cost effective models of care which could increase the span-of healthy life without increasing health care costs.
