Effectiveness of home based support for older people: systematic review and meta-analysisCommentary: When, where, and why do preventive home visits work?

My response is actually meant to be a question to the authors of the
meta-analysis. I apologize if this is not the appropriate forum.

As a geriatrician, I perform comprehensive geriatric assessments in a
clinic setting. A cognitively intact caregiver is always present. In the
context of the lack of geriatric specialists in Canada, clinics have the
advantage of maximizing the number of patients that can be seen by a
specialist. Clearly, some patients cannot attend a clinic without great
difficulty, in which case the assessment takes place in their home.

In the studies that were included in the meta-analysis by Elkan et
al, what types of interventions did the control groups undergo? Did they
receive "usual care" (whatever that means) or did they undergo a
comprehensive geriatric assessment by a geriatric specialist? In other
words, does the meta-analysis suggest that all comprehensive geriatric
assessments by a geriatrician be done in a patient's home, or do the
results simply reflect the benefits of a proper and comprehensive
geriatric assessment compared to usual primary care?

George A. Heckman