Study «Cohen HJ, Feussner JR, Weinberger M ym. A controll...»1

Summary

Randomized controlled trial, year 2002, USA

Population

Hospitalized (11 Veterans Affairs medical centers) frail patients 65 years of age or older (n = 1388), average age was 74 years and 98% were male. Only 3.5% of all patients screened met inclusion criteria and did not meet exclusion criteria (e.g. admitted from nursing home, were already receiving care at geriatric unit or clinic, enrolled in another clinical trial, had severe disabling disease, terminal condition or severe dementia).

Intervention

Randomized two-by-two factorial design to receive either care in inpatient geriatric unit or usual inpatient care. The inpatient teams consisting geriatrician, a social worker, and a nurse.

– They followed standard protocols for geriatric evaluation and management, with specific instructions to complete the history taking and physical examination, including screening for geriatric syndromes such as incontinence or falls, develop a list of problems, assess the patient's functional, cognitive, affective, and nutritional status, evaluate the caregiver's capabilities; and assess the patient's social situation.

– A plan of care was developed, and the team on the geriatric evaluation and management unit met at least twice a week to discuss the plan.

– Preventive and management services (e.g., dietetics, physical and occupational therapy, and clinical pharmacy) were coordinated to address the problems identified, with a general emphasis on maintaining the patient's functional status.

– Inpatients who were assigned to receive usual care received all appropriate hospital services except for those provided by the team on the geriatric evaluation and management unit.

Comparision

Usual inpatient care

Outcome

– Inpatient geriatric evaluation and management had positive effects on physical performance and basic activities of daily living and for SF-36 scores (physical functioning, bodily pain, energy and general health) at the time of discharge, when compared to usual inpatient care.

– Inpatient geriatric evaluation and management did not increase overall costs over the one-year period of the study.

• Study quality: moderate
• Applicability: moderate
• Comment: Inpatient setting is not the best for reaching patients, who may benefit the intervention. In this study only 3.5% of the patients met the criteria in the inpatient setting and 98% were male, who were hospitalized at Veterans Affairs medical centres. The applicability may be better in primary care.