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Lessons Learned and Recommendations for Future Research

Carol H. Winograd, MD; Meghan B. Gerety, MD; Nancy A. Lai

Arch Intern Med. 1993;153(17):2017-2023.

Abstract
Purpose
To determine the effectiveness of inpatient interdisciplinary geriatric consultation provided during hospitalization to frail, elderly subjects.

Subjects and Site
Admission cohort of 197 men admitted from 1985 through 1989, aged 65 years or more, meeting proxy criteria for frailty, living within follow-up area, without terminal illness, and without prolonged nursing home residence.

Methods and Measures
Randomized controlled trial of inpatient geriatric consultation at a tertiary care Veterans Affairs hospital. Differences were determined between groups in the Physical Self-Maintenance Scale, Instrumental Activities of Daily Living, Mini-Mental State Examination, Morale Scale, and nursing home and health care utilization.

Results
No differences were seen between groups in any measure after the intervention or during 1 year of followup. Intervention implementation may have been incomplete due to compliance and resource availability.

Conclusions
This trial is not definitive in determining whether geriatric consultation is effective or ineffective. Lessons learned from this research indicate that future studies should target frail subjects, include intervention-specific measures, and be conducted with direct control of comprehensive resources.

(Arch Intern Med. 1993;153:2017-2023)

Author Affiliations
From the Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, and the Geriatric Research, Education, and Clinical Center, Palo Alto Veterans Affairs Medical Center, Palo Alto, Calif. Dr Gerety is now with the University of Texas Health Sciences Center at San Antonio.

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