A controlled trial of a nursing-centered intervention in hospitalized elderly medical patients: the Yale Geriatric Care Program.
OBJECTIVE
To test the effectiveness of a nursing-centered intervention to prevent functional decline among hospitalized elderly medical patients.


METHODS
Prospective cohort study with stratified and matched cohort analyses.


METHODS
General medicine wards of a university teaching hospital.


METHODS
Two hundred sixteen patients aged > or = 70 years (85 intervention and 131 control patients).


METHODS
The intervention included identification and surveillance of frail older patients, twice-weekly rounds of the Geriatric Care Team, and a nursing-centered educational program.


METHODS
Functional decline, defined as a net decline in five activities of daily living (ADLs).


RESULTS
In stratified analyses, the intervention resulted in a beneficial effect with a relative risk of 0.82 (95% confidence interval [CI] 0.54 to 1.24) in patients (n = 106) with one of four geriatric target conditions at baseline (eg, delirium, functional impairment, incontinence, and pressure sores). The intervention had no effect in patients without target conditions at baseline (n = 110); thus, this subgroup was excluded from further analyses. When patients were matched on number of target conditions and risk for functional decline at baseline (n = 66), the intervention resulted in a significant beneficial effect, with a reduction in functional decline from 64% in controls to 41% in the intervention group, for a relative risk of 0.64 (95% CI, 0.43 to 0.96). The intervention group had significantly less decline in ADL score and in individual ADLs than control subjects. Specific interventions aimed at maximizing function, such as physical therapy, were received more often by intervention patients; however, the beneficial effects of the intervention were achieved without increasing per-day hospital costs.


CONCLUSIONS
The intervention appears effective to decrease functional decline in targeted elderly hospitalized medical patients.
Inouye
S K
SK
Yale University School of Medicine, Yale-New Haven Hospital, CT 06504.
Wagner
D R
DR
Acampora
D
D
Horwitz
R I
RI
Cooney
L M
LM
Tinetii
M E
ME
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003237:Connecticut; D005260:Female; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000458:organization & administration*; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D008297:Male; D016294:Models, Nursing; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011446:Prospective Studies