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Previous Volume 346:905-912 March 21, 2002 Number 12 Next

	Full Text PDF PDA Full Text Perspective by Campion, E. W. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Over the past 20 years, both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management. However, the effects of these interventions on survival and functional status remain uncertain.

Methods We conducted a randomized trial involving frail patients 65 years of age or older who were hospitalized at 11 Veterans Affairs medical centers. After their condition had been stabilized, patients were randomly assigned, according to a two-by-two factorial design, to receive either care in an inpatient geriatric unit or usual inpatient care, followed by either care at an outpatient geriatric clinic or usual outpatient care. The interventions involved teams that provided geriatric assessment and management according to Veterans Affairs standards and published guidelines. The primary outcomes were survival and health-related quality of life, measured with the use of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), one year after randomization. Secondary outcomes were the ability to perform activities of daily living, physical performance, utilization of health services, and costs.

Results A total of 1388 patients were enrolled and followed. Neither the inpatient nor the outpatient intervention had a significant effect on mortality (21 percent at one year overall), nor were there any synergistic effects between the two interventions. At discharge, patients assigned to the inpatient geriatric units had significantly greater improvements in the scores for four of the eight SF-36 subscales, activities of daily living, and physical performance than did those assigned to usual inpatient care. At one year, patients assigned to the outpatient geriatric clinics had better scores on the SF-36 mental health subscale, even after adjustment for the score at discharge, than those assigned to usual outpatient care. Total costs at one year were similar for the intervention and usual-care groups.

Conclusions In this controlled trial, care provided in inpatient geriatric units and outpatient geriatric clinics had no significant effects on survival. There were significant reductions in functional decline with inpatient geriatric evaluation and management and improvements in mental health with outpatient geriatric evaluation and management, with no increase in costs.

Source Information

From the Veterans Affairs Medical Center, Durham, N.C. (H.J.C.); the Veterans Affairs Central Office, Washington, D.C. (J.R.F.); the Veterans Affairs Medical Center, Indianapolis (M.W.); the Veterans Affairs Medical Center, Madison, Wis. (M.C.); the Veterans Affairs Medical Center, Mt. Home, Tenn. (R.C.H.); and the Veterans Affairs Cooperative Studies Program Coordinating Center, Palo Alto, Calif. (F.H., C.P., P.L.).

Other authors were Donald Courtney, M.D., Veterans Affairs Medical Center, Leavenworth, Kans.; Kenneth W. Lyles, M.D., Veterans Affairs Medical Center, Durham, N.C.; Conrad May, M.D., Veterans Affairs Medical Center, Baltimore; Cynthia McMurtry, M.D., Veterans Affairs Medical Center, Richmond, Va.; Leslye Pennypacker, M.D., Veterans Affairs Medical Center, Charleston, S.C.; David M. Smith, M.D., Veterans Affairs Medical Center, Indianapolis; Nina Ainslie, M.D., Veterans Affairs Medical Center, Kansas City, Mo.; Thomas Hornick, M.D., Veterans Affairs Medical Center, Cleveland; and Kayla Brodkin, M.D., Veterans Affairs Medical Center, Seattle.

Address reprint requests to Dr. Cohen at the Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705.

Full Text of this Article

Related Letters:

A Controlled Trial of Geriatric Evaluation
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.
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N Engl J Med 2002; 347:371-373, Aug 1, 2002. Correspondence

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