Evaluation of outpatient geriatric assessment: a randomized multi-site trial.
OBJECTIVE
To evaluate the process and outcome of outpatient consultative geriatric assessment compared with traditional community care.


METHODS
Randomized, controlled clinical trial, with 12-month follow-up.


METHODS
Four hospital-based ambulatory geriatric assessment clinics and community physicians' offices.


METHODS
442 recruited older adults with a health problem or recent change in health status.


METHODS
Outpatient consultative geriatric assessment or usual physician assessment.


METHODS
Identification of health problems, mortality, nursing home admissions, health status, health services utilization, satisfaction with care, and caregiver well-being.


RESULTS
Geriatric assessment, in comparison with usual community care, resulted in the identification of a significantly greater number of patients with cognitive impairment (P < .0001), depression (P = .0004) and incontinence (P < .0001). The group receiving a geriatric assessment had greater improvement in anxiety levels at 1 year (P = .036). Caregivers of participants in the geriatric assessment group had less caregiver stress at 1 year (P = .002). No outcome differences in mortality, nursing home admissions, cognitive health, functional health, or health services utilization were observed. Some evidence of greater patient satisfaction with respect to qualities of the physician was found for the geriatric assessment group.


CONCLUSIONS
Consultative outpatient geriatric assessment led to significantly improved diagnosis of the common health problems of cognitive impairment, depression, and incontinence, to psychological and emotional benefits for patients, and to reduced levels of caregiver stress. Even with limited follow-up care and control of treatment, outpatient geriatric assessment has potential for significant positive effects.
Silverman
M
M
Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
Musa
D
D
Martin
D C
DC
Lave
J R
JR
Adams
J
J
Ricci
E M
EM
D000368:Aged; D000553:Ambulatory Care / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D015397:Program Evaluation; D012017:Referral and Consultation