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Postdischarge Geriatric Assessment of Hospitalized Frail Elderly Patients
Albert L. Siu, MD, MSPH;
Richard L. Kravitz, MD, MSPH;
Emmett Keeler, PhD;
Karen Hemmerling, MPH;
Raynard Kington, MD, PhD;
James W. Davis, MD;
Anne Mitchell, RNP;
Tanya M. Burton, MS;
Hal Morgenstern, PhD;
Mark H. Beers, MD;
David B. Reuben, MD
Arch Intern Med. 1996;156(1):76-81.
Abstract
Background
The diffusion of comprehensive geriatric assessment services has been rather limited in North America partly because of reimbursement and organizational constraints.
Objective
To evaluate the impact of a comprehensive geriatric assessment intervention for frail older patients that is started before hospital discharge and is continued at home.
Methods
Patients older than 65 years were selected who had either unstable medical problems, recent functional limitations, or potentially reversible geriatric clinical problems. Patients (n=354) were randomly assigned to either the intervention group or a control group. Information on survival, readmissions, nursing home placement, medication use, and health status was collected at 30 and 60 days after hospital discharge.
Results
No differences were observed between the two treatment groups in survival, hospital readmission, or nursing home placement by 60 days. After adjustment for baseline characteristics, no significant differences were observed between the two groups on measures of physical functioning, social functioning, role limitations, health perceptions, pain, mental health, energy and/or fatigue, health change, or overall well-being.
Conclusions
Although efficacy has been demonstrated for some forms of comprehensive geriatric assessment, the types of services that are easier to establish (inpatient consultation services and ambulatory assessment) have not been shown to improve outcomes. Our results indicate that outcomes are unaffected by a limited form of comprehensive geriatric assessment begun in the hospital and completed at home. Further efforts are needed to develop and to evaluate realistic approaches to comprehensive geriatric assessment.
(Arch Intern Med. 1996;156:76-81)
Author Affiliations
From the Mount Sinai School of Medicine, New York, NY (Dr Siu); UCLA Schools of Medicine and Public Health, Los Angeles, Calif (Drs Hemmerling, Kington, Davis, Morgenstern, Beers, and Reuben and Ms Mitchell); RAND Health Program, Santa Monica, Calif (Drs Keeler and Burton); and University of California at Davis School of Medicine (Dr Kravitz).
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