Abstract
Background and aims: In a previous publication, we showed that treatment of acutely sick, frail elderly patients in a Geriatric Evaluation and Management Unit (GEMU) reduced mortality considerably when compared with the general Medical Wards (MW). The aim of this presentation was to study the impact of treatment in a GEMU on health care utilization. Methods: Acutely sick, frail patients, 75 years or older, who had been admitted as emergencies to the Department of Internal Medicine were randomized either to treatment in the GEMU (n=127) or to continued treatment in the MW (n=127). While usual treatment was given in the MW, the GEMU emphasized interdisciplinary and comprehensive assessment of all relevant disorders, early mobilization/rehabilitation, and discharge planning. After discharge from hospital, no specific follow-up was offered to any of the groups. Results: Of all subjects, 101 (80%) GEMU and 79 (64%) MW patients were still living in their own homes at three months (p=0.005); at six months the number was 91 (72%) and 74 (60%) (p=0.04) respectively. Median length of index stay was 19 days in the GEMU and 13 days in the MW group (p<0.001). After the initial stay, there were no statistically significant differences in admissions to or time spent in institutions. Conclusions: The results indicate the overall positive treatment effect of acutely sick, frail elderly in a GEMU, i.e. patients treated in the GEMU had increased possibilities of living in their own homes, an effect that was mainly related to considerably reduced mortality in the GEMU group.
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Grimley EJ. 21st Century: Review: ageing and medicine. J Intern Med 2000; 247: 159–67.
Sager MA, Franke T, Inouye SK, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med 1996; 156: 645–52.
Steel K, Gertman PM, Crescenzi C, Anderson J. Iatrogenic illness on a general medical service at a university hospital. N Engl J Med 1981; 304: 638–42.
Gillick MR, Serrell NA, Gillick LS. Adverse consequences of hospitalization in the elderly. Soc Sci Med 1982; 16: 1033–8.
Rubenstein LZ, Josephson K, Wieland GD, et al. Geriatric assessment on a subacute hospital ward. Clin Geriatr Med 1987; 3: 131–43.
Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032–6.
Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med 1995; 332: 1338–44.
Asplund K, Gustafson Y, Jacobsson C, et al. Geriatric-based versus general wards for older acute medical patients: a randomized comparison of outcomes and use of resources. J Am Geriatr Soc 2000; 48: 1381–8.
Counsell SR, Holder CM, Liebenauer LL, et al. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc 2000; 48: 1572–81.
Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA. Kane RL. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med 1984; 311: 1664–70.
Applegate WB, Miller ST, Graney MJ, Elam JT, Burns R, Akins DE. A randomized, controlled trial of a geriatric assessment unit in a community rehabilitation hospital. N Engl J Med 1990; 322: 1572–8.
Cohen HJ, Feussner JR, Weinberger M, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med 2002; 346: 905–12.
Brymer CD, Kohm CA, Naglie G, et al. Do geriatric programs decrease long-term use of acute care beds? J Am Geriatr Soc 1995; 43: 885–9.
Indredavik B, Bakke F, Solberg R, Rokseth R, Haaheim LL, Holme I. Benefit of a stroke unit: a randomized controlled trial. Stroke 1991; 22: 1026–31.
Saltvedt I, Mo ES, Fayers P, Kaasa S, Sletvold O. Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. J Am Geriatr Soc 2002; 50: 792–8.
Winograd CH, Gerety MB, Chung M, Goldstein MK, Dominguez F. Jr. Vallone R. Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc 1991; 39: 778–84.
Harris RD, Henschke PJ, Popplewell PY, et al. A randomised study of outcomes in a defined group of acutely ill elderly patients managed in a geriatric assessment unit or a general medical unit. Aust NZ J Med 1991; 21: 230–4.
Nikolaus T, Specht-Leible N, Bach M, Oster P, Schlierf G. A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients. Age Ageing 1999; 28: 543–50.
Styrborn K. Early discharge planning for elderly patients in acute hospitals — an intervention study. Scand J Soc Med 1995; 23: 273–85.
Hansen FR, Poulsen H, Sorensen KH. A model of regular geriatric follow-up by home visits to selected patients discharged from a geriatric ward: a randomized controlled trial. Aging Clin Exp Res 1995; 7: 202–6.
Stewart S, Pearson S, Luke CG, Horowitz JD. Effects of home-based intervention on unplanned readmissions and out-of-hospital deaths. J Am Geriatr Soc 1998; 46:174–80.
Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA 1999; 281: 613–20.
Melin AL, Bygren LO. Efficacy of the rehabilitation of elderly primary health care patients after short-stay hospital treatment. Med Care 1992; 30: 1004–15.
Hansen FR, Spedtsberg K, Schroll M. Geriatric follow-up by home visits after discharge from hospital: a randomized controlled trial. Age Ageing 1992; 21: 445–50.
Young J, Philp I. Future directions for geriatric medicine. Geriatricians must move with their patients into the community. BMJ 2000; 320: 133–4.
Boult C, Boult LB, Morishita L, Dowd B, Kane RL, Urdangarin CF. A randomized clinical trial of outpatient geriatric evaluation and management. J Am Geriatr Soc 2001; 49: 351–9.
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Saltvedt, I., Saltnes, T., Opdahl Mo, ES. et al. Acute geriatric intervention increases the number of patients able to live at home. A prospective randomized study. Aging Clin Exp Res 16, 300–306 (2004). https://doi.org/10.1007/BF03324555
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DOI: https://doi.org/10.1007/BF03324555