The primary aim of the proposed project is to compare the effectiveness of usual health care (UC), usual health care plus social visits (SV), and usual health care plus a targeted intervention strategy (TI) in reducing falls and improving stability, activity level, and confidence among vulnerable community elderly persons. Secondary aims include describing components of the TI strategy that are effective; describing the characteristics of subjects who appear to benefit from the TI strategy; describing the relationship between reduction in number of risk factors and occurrence of the outcomes; describing pertinent relationships among the outcomes; and comparing overall health care costs among the UC, SV, and TI groups. A matched cohort of physicians employed by a New Haven area health maintenance organization will be randomly allocated to the UC, SV, or TI groups. Then a random sample of 420 eligible patients of these physicians will be assigned to the group of their physician. All subjects will undergo a baseline evaluation by a nurse practitioner and physical therapist and will then be followed for one-year. The UC subjects will otherwise receive only their usual health care; the SV subjects will receive their usual health care plus a series of """"""""social visits"""""""". The TI subjects will receive a multidisciplinary risk abatement strategy targeted at impairments in vision, hearing, postural blood pressure, upper and lower extremity strength and ROM, feet, balance and gait, and simple ADLS as well as at medication usage and environmental fall hazards. Outcomes to be assessed include occurrence of falls and injuries, and changes in balance and gait (stability), activity and mobility level, and confidence (efficacy).
