A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people.
OBJECTIVE
To test Comprehensive Geriatric Assessment (CGA) as an adjunct to usual care.


METHODS
A randomized controlled trial with 3, 6, and 12 months follow-up.


METHODS
Rural communities.


METHODS
A total of 182 of 265 frail older patients (52 refused, 2 withdrawn, 27 ineligible, 2 deaths) referred by family practitioners with allocation to intervention (n = 95) or usual care (n = 87).


METHODS
Three-month implementation of CGA recommendations by a Mobile Geriatric Assessment Team (MGAT) with follow-up assessments at 3, 6, and 12 months. Geriatric nurse assessors, blinded to group assignment, performed each assessment.


METHODS
Goal Attainment Scaling (GAS).


RESULTS
Baseline characteristics were comparable between groups. At 3 months, the intervention group was more likely to attain their goals (GAS total: chi = 46.4 +/- 5.9; GAS outcome chi = 48.0 +/- 6.6) compared with controls (total: chi = 38.7 +/- 4.1; outcome chi = 40.8 +/- 5.6) (P < .001). Standard assessments of function (Barthel index, instrumental activities of daily living), cognition (Mini-Mental State Examination), and quality of life (modified Spitzer quality of life index) showed no difference over 12 months. No difference in survival (intervention: chi = 320 days, SE = 6; control: chi = 294 days, SE = 6; P = .257) or time to institutionalization (intervention: 340 days, SE = 9; control: 342 days, SE = 8; log rank = 0.661; P = .416) were observed.


CONCLUSIONS
A MGAT can target rural dwelling, frail older persons, perform in-home CGA, and develop an intervention strategy. Although the intervention did not prolong life or delay institutionalization, clinically important benefits were observed.
Rockwood
K
K
Division of Geriatric Medicine, Dalhousie University and Centre for Health Care of the Elderly, Halifax, Nova Scotia, Canada.
Stadnyk
K
K
Carver
D
D
MacPherson
K M
KM
Beanlands
H E
HE
Powell
C
C
Stolee
P
P
Thomas
V S
VS
Tonks
R S
RS
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D006040:Goals; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D020380:Needs Assessment / Q000458:organization & administration*; D009674:Nova Scotia; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D015397:Program Evaluation; D011788:Quality of Life; D015203:Reproducibility of Results; D019035:Rural Health Services / Q000458:organization & administration*; D016037:Single-Blind Method