Inpatient community-based geriatric assessment reduces subsequent mortality.
OBJECTIVE
To evaluate the effect of an Inpatient Geriatric Consultation Team on patient outcome.


METHODS
Randomized controlled clinical trial.


METHODS
A non-academic-affiliated 503-bed community hospital.


METHODS
All inpatients over the age of 70 years. Sixty-two patients received multidimensional geriatric assessment, and 58 patients received no intervention.


METHODS
Team assessment, leading to formal recommendations to the attending physician.


METHODS
Data were collected on hospital length of stay, referrals to community service, discharge destination, hospital readmissions in 6 months, number of post-discharge physician visits, and change in functional status. Mortality at 6 months and at 1 year was determined for each patient.


RESULTS
At 6 months, 12/58 patients (21%) had died in the control group versus 3/62 (6%) patients in the experimental group (P = 0.01). During hospitalization, the length-of-stay was 10.1 days for the control group versus 9.0 days for the experimental group (P = 0.20). The control group had significantly more readmissions (0.6 per patient vs 0.3 per patient, P = 0.02). A higher number of experimental patients, 22% (13/59), showed improvement in ADL scores compared with 7% (4/46) of control patients, P = 0.07. At one year for all randomized patients, 7/68 (10%) of experimental patients and 13/64 (20%) of control patients had died.


CONCLUSIONS
Short-term mortality can be reduced in community inpatient acute hospital settings by comprehensive geriatric consultation teams. Important differences in mortality remain at 1 year of followup. Trends towards improved functional status and fewer hospital readmissions favor the intervention group.
Thomas
D R
DR
Section on Internal Medicine and Gerontology, Wake Forest University, Winston-Salem, North Carolina.
Brahan
R
R
Haywood
B P
BP
D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D015577:Geriatric Assessment; D006746:Hospital Bed Capacity, 500 and over; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D008297:Male; D009026:Mortality; D010359:Patient Readmission