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A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients
Abstract
OBJECTIVE: to prove the effectiveness of geriatric evaluation and management for elderly, hospitalized patients, combined with post-discharge home intervention by an interdisciplinary team. DESIGN: randomized controlled trial with outcome and costs assessed for 12 months after the date of admission. SETTING: university-affiliated geriatric hospital and the homes of elderly patients. SUBJECTS: 545 patients with acute illnesses admitted from home to the geriatric hospital. INTERVENTIONS: patients were randomly assigned to receive either comprehensive geriatric assessment and post-discharge home intervention (intervention), comprehensive geriatric assessment alone (assessment) or usual care. MAIN OUTCOME MEASURES: survival, functional status, rehospitalization, nursing home placement and direct costs over 12 months. RESULTS: the intervention group showed a significant reduction in length of hospital stay (33.49 days vs 40.7 days in the assessment group and 42.7 days in the control group; P < 0.05) and rate of immediate nursing home placement (4.4% vs 7.3% and 8.1%; P < 0.05). There was no difference in survival, acute care hospital readmissions or new admissions to nursing homes but the intervention group had significantly shorter hospital readmissions (22.2 days vs 34.2 days and 35.7 days; P < 0.05) and nursing home placements (114.7 days vs 161.6 days and 170.0 days; P < 0.05). Direct costs were lower in the intervention group [about DM 7000 (US $4000) per person per year]. Functional capacities were significantly better in the intervention group. CONCLUSIONS: comprehensive geriatric assessment in combination with post-discharge home intervention does not improve survival, but does improve functional status and can reduce the length of the initial hospital stay and of subsequent readmissions. It can reduce the rate of immediate nursing home admissions and delay permanent nursing home placement. It may also substantially reduce direct costs of hospitalized patients.
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Cites
Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living
Lawton, M. P., & Brody, E. M. (1969) · The Gerontologist · doi:10.1093/geront/9.3_part_1.179 · Cited by 18,540
Comprehensive geriatric assessment: a meta-analysis of controlled trials
Stuck, A. E., Siu, A. L., Wieland, G. D., Rubenstein, L. Z., & Adams, J. (1993) · The Lancet · doi:10.1016/0140-6736(93)92884-v · Cited by 1,974
Cited by
Comprehensive geriatric assessment for older adults admitted to hospital
Ellis, G., Whitehead, M. A., O'Neill, D., Langhorne, P., & Robinson, D. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006211.pub2 · Cited by 1,114
Use of comprehensive geriatric assessment in older cancer patients:
Extermann, M., Aapro, M., Bernabei, R., Cohen, H. J., Droz, J.-P., Lichtman, S., Mor, V., Monfardini, S., Repetto, L., Sørbye, L., et al. (2005) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2005.06.003 · Cited by 1,098
Ellis, G., Whitehead, M. A., Robinson, D., O'Neill, D., & Langhorne, P. (2011) · BMJ · doi:10.1136/bmj.d6553 · Cited by 1,068
Comprehensive geriatric assessment for older adults admitted to hospital
Ellis, G., Gardner, M., Tsiachristas, A., Langhorne, P., Burke, O., Harwood, R. H., Conroy, S. P., Kircher, T., Somme, D., Saltvedt, I., et al. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006211.pub3 · Cited by 853
Beswick, A. D., Rees, K., Dieppe, P., Ayis, S., Gooberman-Hill, R., Horwood, J., & Ebrahim, S. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60342-6 · Cited by 780
Metadata
- Authors
- Nikolaus, T.
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 1999-10-01
- Volume
- 28
- Issue
- 6
- Pages
- 543-550
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- OpenAlex
- W2147051349
- Cited by
- 225
- References
- 2
- FWCI
- 5.40
- Type
- journal article
- Language
- en
- Open access
- closed
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