Lourdes Rexach, MD, PhD Coordinator of Palliative Care Unit University Hospital Ramo ´ n y Cajal Madrid, Spain Miel Ribbe, MD, PhD VU University Medical Center Amsterdam, the Netherlands Nele Van Den Noortgate, MD, PhD Department of Geriatric Medicine University Hospital Ghent, Ghent, Belgium ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Sophie Pautex, Vito Curiale, Lourdes Rexach, and Nele Van Den Noortgate: study con- cept and design, acquisition of subjects and data, analysis and interpretation of data, and preparation of manuscript. Mathias Pfisterer and Miel Ribbe: study concept and design, acquisition of subjects and data, analysis and inter- pretation of data. Sponsor’s Role: None. REFERENCES 1. Davies E, Higginson IJ, editors. Better Palliative Care for Older People. Geneva: World Health Organization, 2004. 2. An ageing problem. Lancet Oncol 2004;5:459. 3. Fried LP, Ferrucci L, Darer J et al. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59A:255–263. 4. Kapo J, Morrison LJ, Liao S. Palliative care for the older adult. J Palliat Med 2007;10:185–209. 5. Goldstein NE, Morrison RS. The intersection between geriatrics and palliative care: A call for a new research agenda. J Am Geriatr Soc 2005;53:1593–1598. 6. Burt J, Raine R. The effect of age on referral to and use of specialist palliative care services in adult cancer patients: A systematic review. Age Ageing 2006;35:469–476. 7. Coleman EA, Boult C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc 2003;51:556–557. 8. Evers MM, Meier DE, Morrison RS. 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COMMUNITY-BASED GERIATRIC ASSESSMENT AND PREVENTIVE INTERVENTION LOWERED MEDICAL EXPENSES FOR THE ELDERLY To the Editor: Before the introduction of the national long- term care insurance system, it was reported that commu- nity-based geriatric assessment might lower the increasing rate of medical expenses in a rural town in Kochi Prefecture, Japan. 1 Even after the introduction of the national long-term care insurance system in 2000, total medical ex- penses for older adults has increased with the growth of the older population in Japan. Since 2004, community- based comprehensive geriatric assessments and interven- tions have been performed for older adults living in Tosa Town, Kochi Prefecture, Japan. Geriatric assessments in- cluded a comprehensive annual health-related question- naire of all eligible people aged 65 and older (75–95% response rate) and annual geriatric examinations for people aged 75 and older (30–40% participant rate). 2 This longi- tudinal community-based project in cooperation with local government and resident organizing committees has at- tained several medical achievements: early detection of la- tent diabetes mellitus or impaired glucose tolerance in older adults because of community-based oral glucose tolerance tests, 3 improvement of impaired glucose tolerance by life- style change interventions, 4 increasing public awareness of hypertension in older adults, 5 public education of dietary diversity, 6 and early detection of fallers 7 by introducing a fall risk index that can be completed in a brief amount of time. 8 In parallel with medical and geriatric achievements of the community-based project, an additional achievement regarding changes in medical expenses for the elderly in this town was found. Changes in medical expenses from 2004 to 2007 in Tosa Town, where we have intervened, compared with medical expenses for older adults in two other com- munities (Motoyama Town and Kochi City) in Kochi pre- fecture and the average medical expenses of 35 communities in Kochi Prefecture 9 are reported here. Kochi prefecture is located in Shikoku province in southwestern Japan and has 11 cities and 24 towns with a total popu- lation of 796,292 people, of whom 25.9% were aged 65 and older in 2006. Tosa Town is one of the 24 small towns in Kochi Prefecture and had a population of 4,632 people, of whom 40.6% were aged 65 and older in 2006. This comparative study on changes in medical expenses for older adults included two control communities: Motoyama Town, which neighbors Tosa Town and has a sociodemo- graphic profile similar to that of Tosa Town, and Kochi City, which is the seat of Kochi prefecture. Total popula- tions (and % of the population aged  65) in Motoyama Town and Kochi City in 2006 were 4,374 (37.9%) and 333,484 (20.5%), respectively. Figure 1 compares annual changes in medical expenses in the national medical insurance system for one person aged 65 and older in Tosa Town from 2004 to 2007 with expenses in Motoyama Town, in Kochi City, and the av- erage from 35 communities in Kochi Prefecture. Although medical expenses for older adults increased over the 4 years in Motoyama Town and Kochi City and in Kochi prefecture in general, expenses in Tosa Town decreased yearly from 2004 to 2007. The decrease in medical expenses for older adults in Tosa Town is probably due to community-based geriatric assessments and preventive interventions intro- duced since 2004. In 2007, differences in medical expenses between Tosa Town and neighboring Motoyama Town reached 140,000 Japanese yen (approximately $1,075) for each elderly person each year, which totals approxi- LETTERS TO THE EDITOR 791 JAGS APRIL 2010–VOL. 58, NO. 4