A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients
1 Department of Psychiatry, University of Tübingen, Osianderstr. 24, D-72076 Tübingen, Germany
2 Department of Psychiatry and Psychotherapy, RWTH Aachen University, Pauwelstr. 30, D-52076 Aachen, Germany
3 Städtisches Krankenhaus Rottenburg, Königstr. 57, D-72108 Rottenburg am Neckar, Germany
4 Kreisklinik Reutlingen, Geriatrischer Schwerpunkt, Steinenbergstr. 31, D-72764 Reutlingen, Germany
5 Zollernalbklinikum Hechingen, Geriatrischer Schwerpunkt, Weilheimer Str. 31, D-72379 Hechingen, Germany
6 Institute for Medical Information Processing, University of Tübingen, Westbahnhofstraße 55, D-72070 Tübingen, Germany
Address correspondence to: T. T. J. Kircher. Tel: (+49) 241 8089637; Fax: (+49) 241 8089633. Email: tkircher{at}ukaachen.de
Background: the usefulness of geriatric evaluation and management (GEM) approaches in the care of frail elderly patients remains uncertain. We examined whether an inpatient geriatric consultation service might be beneficial in a country with a social welfare system.
Methods: we conducted a randomised trial with 345 patients from five centres. Ninety additional patients from four separate centres without GEM teams served as an external comparison. All patients were hospitalised, at least 65 years and frail. Patients were randomly assigned to either comprehensive geriatric assessment and management in the form of consultations and follow-up or usual care. Primary outcomes were rehospitalisation and nursing home placement 1 year after randomisation. Secondary outcomes were survival, functional, emotional and cognitive status, social situation and quality of life.
Findings: at 12 months, the groups did not differ in the rate of rehospitalisation (intervention 67%, control 60%, P = 0.30), nursing home placement (intervention 19%, control 14%, P = 0.27), survival (intervention 81%, control 85%, P = 0.56) or any of the other secondary measures. The external comparison groups were also similar in nursing home placement (16%, P = 0.40), survival (80%, P = 0.88) and all the secondary variables, but rehospitalisation was less (48%, P = 0.04). No subgroup benefited from the intervention.
Interpretation: care provided by consultation teams did not improve the rates of rehospitalisation or nursing home placement. This is not due to carry-over effects of geriatric knowledge into the control group.
Keywords: geriatric consultation, inpatient, acute care, elderly
Received 29 July 2005; accepted in revised form 13 July 2006.
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