Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial.
OBJECTIVE
Documentation of treatment effects in acutely sick frail older patients in geriatric evaluation and management units (GEMUs) is scarce. The present study evaluated whether treatment in a GEMU would reduce mortality as compared to traditional treatment delivered in the Department of Internal Medicine.


METHODS
Prospective randomized trial.


METHODS
GEMU or general medical ward.


METHODS
Acutely sick frail patients aged 75 and older who had been admitted to the Department of Internal Medicine were randomly assigned to treatment in the GEMU (n = 127) or to the general medical wards (n = 127). The following inclusion criteria were used to target frail patients: chronic disability, acute impairment of single activity of daily living, mild/moderate dementia, confusion, depression, imbalance/dizziness, falls, impaired mobility, urinary incontinence, malnutrition, polypharmacy, vision or hearing impairment, social problems, or prolonged bedrest.


METHODS
In the GEMU, the treatment strategy emphasized interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilization/rehabilitation, and comprehensive discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow-up.


METHODS
Mortality and causes of death.


RESULTS
Mortality in the intervention and control groups, respectively, was 12% and 27% at 3 months (P =.004), 16% and 29% (P =.02) at 6 months, and 28% and 34% (P =.06) at 12 months. The hazard ratio was 0.39 (95% confidence interval = 0.21-0.72) at 3 months. The main cause of death was cardiovascular disease.


CONCLUSIONS
Treatment of acutely sick, frail, older patients in a GEMU substantially reduced mortality.
Saltvedt
Ingvild
I
Section of Geriatrics, Department of Internal Medicine, University Hospital of Trondheim, Trondheim, Norway. ingvild.saltvedt@medisin.ntnu.no
Mo
Ellen-Sofie Opdahl
ES
Fayers
Peter
P
Kaasa
Stein
S
Sletvold
Olav
O
D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008297:Male; D009026:Mortality; D011446:Prospective Studies; D011788:Quality of Life