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Inpatient Community‐Based Geriatric Assessment Reduces Subsequent Mortality
Author(s) -
Thomas David R.,
Brahan Robert,
Haywood Barry P.
Publication year - 1993
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1993.tb02040.x
Subject(s) - medicine , randomized controlled trial , geriatrics , intervention (counseling) , emergency medicine , clinical trial , community hospital , activities of daily living , physical therapy , nursing , psychiatry
Objective To evaluate the effect of an Inpatient Geriatric Consultation Team on patient outcome. Design Randomized controlled clinical trial. Setting A non‐academic‐affiliated 503‐bed community hospital. Patients All inpatients over the age of 70 years. Sixty‐two patients received multidimensional geriatric assessment and 58 patients received no intervention. Intervention Team assessment, leading to formal recommendations to the attending physician. Measurements Data were collected on hospital length of stay, referrals to community service, discharge destination, hospital readmissions in 6 months, number of post‐discharge physician visits, and change in functional status. Mortality at 6 months and at 1 year was determined for each patient. Main Results At 6 months, 12/58 patients (21%) had died in the control group versus 3/62 (6%) patients in the experimental group ( P = 0.01). During hospitalization, the length‐of‐stay was 10.1 days for the control group versus 9.0 days for the experimental group ( P = 0.20). The control group had significantly more readmissions (0.6 per patient vs 0.3 per patient, P = 0.02). A higher number of experimental patients, 22% (13/59), showed improvement in ADL scores compared with 7% (4/46) of control patients, P = 0.07. At one year for all randomized patients, 7/68 (10%) of experimental patients and 13/64 (20%) of control patients had died. Conclusions Short‐term mortality can be reduced in community inpatient acute hospital settings by comprehensive geriatric consultation teams. Important differences in mortality remain at 1 year of followup. Trends towards improved functional status and fewer hospital readmissions favor the intervention group.