Age and Ageing, Vol 28, 543-550, Copyright © 1999 by British Geriatrics Society
T Nikolaus, N Specht-Leible, M Bach, P Oster and G Schlierf
OBJECTIVE: to prove the effectiveness of geriatric evaluation and
management for elderly, hospitalized patients, combined with post-
discharge home intervention by an interdisciplinary team. DESIGN:
randomized controlled trial with outcome and costs assessed for 12 months
after the date of admission. SETTING: university-affiliated geriatric
hospital and the homes of elderly patients. SUBJECTS: 545 patients with
acute illnesses admitted from home to the geriatric hospital.
INTERVENTIONS: patients were randomly assigned to receive either
comprehensive geriatric assessment and post-discharge home intervention
(intervention), comprehensive geriatric assessment alone (assessment) or
usual care. MAIN OUTCOME MEASURES: survival, functional status,
rehospitalization, nursing home placement and direct costs over 12 months.
RESULTS: the intervention group showed a significant reduction in length of
hospital stay (33.49 days vs 40.7 days in the assessment group and 42.7
days in the control group; P < 0.05) and rate of immediate nursing home
placement (4.4% vs 7.3% and 8.1%; P < 0.05). There was no difference in
survival, acute care hospital readmissions or new admissions to nursing
homes but the intervention group had significantly shorter hospital
readmissions (22.2 days vs 34.2 days and 35.7 days; P < 0.05) and
nursing home placements (114.7 days vs 161.6 days and 170.0 days; P <
0.05). Direct costs were lower in the intervention group [about DM 7000 (US
$4000) per person per year]. Functional capacities were significantly
better in the intervention group. CONCLUSIONS: comprehensive geriatric
assessment in combination with post-discharge home intervention does not
improve survival, but does improve functional status and can reduce the
length of the initial hospital stay and of subsequent readmissions. It can
reduce the rate of immediate nursing home admissions and delay permanent
nursing home placement. It may also substantially reduce direct costs of
hospitalized patients.
ARTICLES
A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients
Department of Geriatric Medicine, University of Ulm and Bethesda Geriatric Clinic, Germany. thorsten.nikolaus@medizin.uni-ulm.de
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