We randomly assigned frail elderly inpatients with a high probability of nursing-home placement to an innovative geriatric evaluation unit intended to provide improved diagnostic assessment, therapy, rehabilitation, and placement. Patients randomly assigned to the experimental (n = 63) and control (n = 60) groups were equivalent at entry. At one year, patients who had been assigned to the geriatric unit had much lower mortality than controls (23.8 vs. 48.3 per cent, P less than 0.005) and were less likely to have initially been discharged to a nursing home (12.7 vs. 30.0 per cent, P less than 0.05) or to have spent any time in nursing home during the follow-up period (26.9 vs. 46.7 per cent, P less than 0.05). The control-group patients had substantially more acute-care hospital days, nursing-home days, and acute-care hospital readmissions. Patients in the geriatric unit were significantly more likely to have improvement in functional status and morale than controls (P less than 0.05). Direct costs for institutional care were lower for the experimental group, especially after adjustment for survival. We conclude that geriatric evaluation units can provide substantial benefits at minimal cost for appropriate groups of elderly patients, over and above the benefits of traditional hospital approaches.
This article has been cited by other articles:
Di Bari, M., Balzi, D., Roberts, A. T., Barchielli, A., Fumagalli, S., Ungar, A., Bandinelli, S., De Alfieri, W., Gabbani, L., Marchionni, N.
(2009). Prognostic Stratification of Older Persons Based on Simple Administrative Data: Development and Validation of the "Silver Code," To Be Used in Emergency Department Triage. J Gerontol A Biol Sci Med Sci
0: glp043v3-glp043
[Abstract][Full Text]
Mas, M. A., Renom, A., Vazquez, O., Miralles, R., Bayer, A. J., Cervera, A. M.
(2009). Interruptions to rehabilitation in a geriatric rehabilitation unit: associated factors and consequences. Age Ageing
38: 346-349
[Full Text]
Denaro, C P, Mudge, A
(2008). Should geriatric medicine remain a specialty? No. BMJ
337: a515-a515
[Full Text]
Wieland, D., Ferrucci, L.
(2008). Multidimensional Geriatric Assessment: Back to the Future. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
63: 272-274
[Full Text]
Kircher, T. T. J., Wormstall, H., Muller, P. H., Schwarzler, F., Buchkremer, G., Wild, K., Hahn, J.-M., Meisner, C.
(2007). A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients. Age Ageing
36: 36-42
[Abstract][Full Text]
Parker, S. G., Fadayevatan, R., Lee, S. D.
(2006). Acute hospital care for frail older people. Age Ageing
35: 551-552
[Full Text]
Pahor, M.
(2006). Randomized controlled trials involving multidisciplinary interventions in the community.. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
61: 472-473
[Abstract][Full Text]
Kuriyama, S., Hozawa, A., Ohmori, K., Shimazu, T., Matsui, T., Ebihara, S., Awata, S., Nagatomi, R., Arai, H., Tsuji, I.
(2006). Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project 1. Am. J. Clin. Nutr.
83: 355-361
[Abstract][Full Text]
Freyer, G., Braud, A.-C., Chaibi, P., Spielmann, M., Martin, J.-P., Vilela, G., Guerin, D., Zelek, L.
(2006). Dealing with metastatic breast cancer in elderly women: results from a French study on a large cohort carried out by the 'Observatory on Elderly Patients'. Ann Oncol
17: 211-216
[Abstract][Full Text]
Engelhardt, J. B., Toseland, R. W., Gao, J., Banks, S.
(2006). Long-Term Effects of Outpatient Geriatric Evaluation and Management on Health Care Utilization, Cost, and Survival. Research on Social Work Practice
16: 20-27
[Abstract]
Altimir, S., Lupon, J., Gonzalez, B., Prats, M., Parajin, T., Urrutia, A., Coll, R., Valle, V.
(2005). Sex and age differences in fragility in a heart failure population. Eur J Heart Fail
7: 798-802
[Abstract][Full Text]
Rao, A. V., Hsieh, F., Feussner, J. R., Cohen, H. J.
(2005). Geriatric Evaluation and Management Units in the Care of the Frail Elderly Cancer Patient. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
60: 798-803
[Abstract][Full Text]
Boyd, C. M., Xue, Q.-L., Guralnik, J. M., Fried, L. P.
(2005). Hospitalization and Development of Dependence in Activities of Daily Living in a Cohort of Disabled Older Women: The Women's Health and Aging Study I. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
60: 888-893
[Abstract][Full Text]
Ellis, G., Langhorne, P.
(2005). Comprehensive geriatric assessment for older hospital patients. Br Med Bull
71: 45-59
[Abstract][Full Text]
Ferrucci, L.
(2005). An Exciting Thought. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
60: 56-56
[Full Text]
Morley, J. E.
(2004). A Brief History of Geriatrics. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
59: 1132-1152
[Full Text]
Rubenstein, L. Z.
(2004). Joseph T. Freeman Award Lecture: Comprehensive Geriatric Assessment: From Miracle to Reality. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
59: M473-M477
[Full Text]
Yazgan, I. C., Greenwald, B. S., Kremen, N. J., Strach, J., Kramer-Ginsberg, E.
(2004). Geriatric Psychiatry Versus General Psychiatry Inpatient Treatment of the Elderly. Am. J. Psychiatry
161: 352-355
[Abstract][Full Text]
Morley, J. E.
(2004). The Top 10 Hot Topics in Aging. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
59: M24-33
[Full Text]
Landefeld, C S.
(2003). Improving Health Care for Older Persons. ANN INTERN MED
139: 421-424
[Abstract][Full Text]
Morley, J. E., Flaherty, J. H., Thomas, D. R.
(2003). Editorial: Geriatricians, Continuous Quality Improvement, and Improved Care for Older Persons. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
58: M809-812
[Full Text]
Jordhoy, M. S, Saltvedt, I., Fayers, P., HaKvard, J., Ahlner-Elmqvist, M., Kaasa, S.
(2003). Which cancer patients die in nursing homes? Quality of life, medical and sociodemographic characteristics. Palliat Med
17: 433-444
[Abstract]
Capitman, J.
(2003). Effective Coordination of Medical and Supportive Services. J Aging Health
15: 124-164
[Abstract]
Stuck, A. E., Egger, M., Beck, J. C., Bernabei, R., Gambassi, G., Carbonin, P., Nikolaus, T., Becker, C., Meuleman, J., Cohen, H. J., Weinberger, M., Feussner, J. R.
(2002). A Controlled Trial of Geriatric Evaluation. NEJM
347: 371-373
[Full Text]
Cohen, H. J., Feussner, J. R., Weinberger, M., Carnes, M., Hamdy, R. C., Hsieh, F., Phibbs, C., Courtney, D., Lyles, K. W., May, C., McMurtry, C., Pennypacker, L., Smith, D. M., Ainslie, N., Hornick, T., Brodkin, K., Lavori, P.
(2002). A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management. NEJM
346: 905-912
[Abstract][Full Text]
Malphurs, F. L., Striano, J. A.
(2001). Gaze Into the Long-term Care Crystal Ball: The Veterans Health Administration and Aging. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
56: M666-673
[Abstract][Full Text]
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., McBurnie, M. A.
(2001). Frailty in Older Adults: Evidence for a Phenotype. Journals of Gerontology Series A: Biological Sciences and Medical Sciences
56: 146M-157
[Abstract][Full Text]
Ganz, P. A., Greendale, G. A., Petersen, L., Zibecchi, L., Kahn, B., Belin, T. R.
(2000). Managing Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial. JNCI J Natl Cancer Inst
92: 1054-1064
[Abstract][Full Text]
Hamerman, D.
(1999). Toward an Understanding of Frailty. ANN INTERN MED
130: 945-950
[Full Text]
Inouye, S. K., Bogardus, S. T., Charpentier, P. A., Leo-Summers, L., Acampora, D., Holford, T. R., Cooney, L. M.
(1999). A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients. NEJM
340: 669-676
[Abstract][Full Text]
Rice-Oxley, M., Turner-Stokes, L.
(1999). Effectiveness of brain injury rehabilitation. Clin Rehabil
13: 7-24
[Abstract]
Frezza, E. E., SquillariO, D. M., Smith, T. J.
(1998). The Ethical Challenge and the Futile Treatment in the Older Population Admitted to the Intensive Care Unit. American Journal of Medical Quality
13: 121-126
[Abstract]
Landi, F., Bernabei, R., Gambassi, G., Clark, F. A.
(1998). Occupational Therapy and Outcomes for Older Adults. JAMA
279: 582-582
[Full Text]
O'Donnell, J. C., Toseland, R. W.
(1997). Does Geriatric Evaluation and Management Improve the Health Behavior of Older Veterans in Psychological Distress?. J Aging Health
9: 473-497
[Abstract]
WIELAND, D., KRAMER, B. J., WAITE, M. S., RUBENSTEIN, L. Z.
(1996). The Interdisciplinary Team in Geriatric Care. American Behavioral Scientist
39: 655-664
[Abstract]
McCormick, W. C., Inui, T. S., Roter, D. L.
(1996). Interventions in Physician-Elderly Patient Interactions. Research on Aging
18: 103-136
[Abstract]
Greganti, M. A., Hanson, L. C.
(1996). Comprehensive Geriatric Assessment: Where Do We Go From Here?. Arch Intern Med
156: 15-17
[Abstract]
Siu, A. L., Kravitz, R. L., Keeler, E., Hemmerling, K., Kington, R., Davis, J. W., Mitchell, A., Burton, T. M., Morgenstern, H., Beers, M. H., Reuben, D. B.
(1996). Postdischarge Geriatric Assessment of Hospitalized Frail Elderly Patients. Arch Intern Med
156: 76-81
[Abstract]
Stuck, A. E., Aronow, H. U., Steiner, A., Alessi, C. A., Bula, C. J., Gold, M. N., Yuhas, K. E., Nisenbaum, R., Rubenstein, L. Z., Beck, J. C.
(1995). A Trial of Annual in-Home Comprehensive Geriatric Assessments for Elderly People Living in the Community. NEJM
333: 1184-1189
[Abstract][Full Text]
Wieland, D., Stuck, A. E., Siu, A. L., adams, J., Rubenstein, L. Z.
(1995). Meta-Analytic Methods for Health Services Research: An Example from Geriatrics. Eval Health Prof
18: 252-282
[Abstract]
Burns, R., Nichols, L. O., Graney, M. J., Cloar, F. T.
(1995). Impact of Continued Geriatric Outpatient Management on Health Outcomes of Older Veterans. Arch Intern Med
155: 1313-1318
[Abstract]
Landefeld, C. S., Palmer, R. M., Kresevic, D. M., Fortinsky, R. H., Kowal, J.
(1995). A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients. NEJM
332: 1338-1344
[Abstract][Full Text]
Campion, E. W.
(1995). The Value of Geriatric Interventions. NEJM
332: 1376-1378
[Full Text]
Wilson, I. B., Cleary, P. D.
(1995). Linking Clinical Variables With Health-Related Quality of Life: A Conceptual Model of Patient Outcomes. JAMA
273: 59-65
[Abstract]
Bentur, N., Eldar, R., Davies, M. A
(1994). Process and outcome of care: comparison of two inpatient geriatric rehabilitation settings. Clin Rehabil
8: 307-313
[Abstract]
Mulrow, C. D., Gerety, M. B., Kanten, D., Cornell, J. E., DeNino, L. A., Chiodo, L., Aguilar, C., O'Neil, M. B., Rosenberg, J., Solis, R. M.
(1994). A Randomized Trial of Physical Rehabilitation for Very Frail Nursing Home Residents. JAMA
271: 519-524
[Abstract]
Winograd, C. H., Gerety, M. B., Lai, N. A.
(1993). A Negative Trial of Inpatient Geriatric Consultation: Lessons Learned and Recommendations for Future Research. Arch Intern Med
153: 2017-2023
[Abstract]
Ehreth, J.
(1992). Cost Methodology in Long-Term Care Evaluations. Med Care Res Rev
49: 331-353
Smith, C. B., Wolcott, M.
(1991). Veterans Health Care: Lessons for a National Health Care System. ANN INTERN MED
115: 907-909
[Abstract]
Deyo, R. A.
(1991). The Quality of Life, Research, and Care. ANN INTERN MED
114: 695-697
[Abstract]
(1990). American Medical Association White Paper on Elderly Health: Report of the Council on Scientific Affairs. Arch Intern Med
150: 2459-2472
[Abstract]
Rubenstein, L. Z., Robbins, A. S., Josephson, K. R., Schulman, B. L., Osterweil, D.
(1990). The Value of Assessing Falls in an Elderly Population: A Randomized Clinical Trial. ANN INTERN MED
113: 308-316
[Abstract]
Epstein, A. M., Hall, J. A., Fretwell, M., Feldstein, M., DeCiantis, M. L., Tognetti, J., Cutler, C., Constantine, M., Besdine, R., Rowe, J., McNeil, B. J.
(1990). Consultative Geriatric Assessment for Ambulatory Patients: A Randomized Trial in a Health Maintenance Organization. JAMA
263: 538-544
[Abstract]
Roth, E., Davidoff, G., Haughton, J., Ardner, M.
(1990). Functional assessment in spinal cord injury: a comparison of the Modified Barthel Index and the 'adapted' Functional Independence Measure. Clin Rehabil
4: 277-285
[Abstract]
Rubenstein, L. V., Calkins, D. R., Young, R. T., Cleary, P. D., Fink, A., Kosecoff, J., Jette, A. M., Davies, A. R., Delbanco, T. L., Brook, R. H.
(1989). Improving Patient Function: A Randomized Trial of Functional Disability Screening. ANN INTERN MED
111: 836-842
[Abstract]
McCusker, J., Mundt, D. J., Stoddard, A. M., Cole, E., Whitbourne, S. K., Simmons, J. E.
(1989). Outcomes of a Geriatric Rehabilitation Program in a Long-Term Care Facility. J Aging Health
1: 485-506
[Abstract]
McVey, L. J., Becker, P. M., Saltz, C. C., Feussner, J. R., Cohen, H. J.
(1989). Effect of a Geriatric Consultation Team on Functional Status of Elderly Hospitalized Patients: A Randomized, Controlled Clinical Trial. ANN INTERN MED
110: 79-84
[Abstract]
Friedman, P. J.
(1988). Financing Long-Term Care. ANN INTERN MED
109: 172-173
[Abstract]
Health and Public Policy Committee,
(1988). Comprehensive Functional Assessment for Elderly Patients. ANN INTERN MED
109: 70-72
[Abstract]
SOLOMON, D. H., JUDD, H. L., SIER, H. C., RUBENSTEIN, L. Z., MORLEY, J. E.
(1988). New Issues in Geriatric Care. ANN INTERN MED
108: 718-732
[Abstract]
Becker, P. M., McVey, L. J., Saltz, C. C., Feussner, J. R., Cohen, H. J.
(1987). Hospital-Acquired Complications in a Randomized Controlled Clinical Trial of a Geriatric Consultation Team. JAMA
257: 2313-2317
[Abstract]
Campion, E. W.
(1987). The Merits of Geriatric Consultation. JAMA
257: 2336-2337
[Abstract]
Rubenstein, L. Z.
(1987). Exposing the Iceberg of Unrecognized Disability: The Benefits of Functional Assessment of the Elderly. Arch Intern Med
147: 419-420
[Abstract]
Pinholt, E. M., Kroenke, K., Hanley, J. F., Kussman, M. J., Twyman, P. L., Carpenter, J. L.
(1987). Functional Assessment of the Elderly: A Comparison of Standard Instruments With Clinical Judgment. Arch Intern Med
147: 484-488
[Abstract]
GILLICK, M. R.
(1987). The Impact of Health Maintenance Organizations on Geriatric Care. ANN INTERN MED
106: 139-143
[Abstract]
Allen, C. M., Becker, P. M., McVey, L. J., Saltz, C., Feussner, J. R., Cohen, H. J.
(1986). A Randomized, Controlled Clinical Trial of a Geriatric Consultation Team: Compliance With Recommendations. JAMA
255: 2617-2621
[Abstract]
WILLIAMS, M. E.
(1986). Geriatric Assessment. ANN INTERN MED
104: 720-721
[Abstract]
Previous
