Geriatric evaluation and management units in the care of the frail elderly cancer patient.
BACKGROUND
Geriatric assessment has been suggested as a possibly useful approach in dealing with frail elderly cancer patients.


METHODS
This was a secondary subset analysis from a randomized 2 x 2 factorial trial in 11 Department of Veterans Affairs medical centers. Hospitalized, frail patients at least 65 years old, after stabilization of their acute illness, were randomized to receive care in a geriatric inpatient unit, a geriatric outpatient clinic, both, or neither. The interventions involved core teams that provided geriatric assessment and patient management. We identified 99 patients with a diagnosis of cancer by The International Classification of Diseases, 9th Revision (ICD-9) codes, excluding all nonmelanoma skin cancers. Outcomes collected at discharge, 6 months, and 1 year after randomization were survival, changes in health-related quality of life (using the Medical Outcomes Study 36-Item Short-Form general health survey [SF-36]), activities of daily living, physical performance, health service utilization, and costs.


RESULTS
There was no effect on mortality (1-year survival 59.6%). The changes in the SF-36 scores from randomization for emotional limitation, mental health and bodily pain (also sustained at 1 year) on the SF-36 were better for geriatric inpatient care cancer patients at discharge. There was no difference in SF-36 scores between geriatric outpatient and usual outpatient care. Days of hospitalization and overall costs were equivalent for the interventions and usual care over the 1-year study.


CONCLUSIONS
This study suggests that inpatient geriatric assessment and management may be an effective approach to the management of pain and psychological status in the elderly cancer inpatient at no greater length of hospitalization or extra cost than usual care.
Rao
Arati V
AV
Geriatric Research, Education and Clinical Center (GRECC) Veterans Administration Medical Center, and Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA. rao00012@mc.duke.edu
Hsieh
Frank
F
Feussner
John R
JR
Cohen
Harvey Jay
HJ
D000203:Activities of Daily Living; D000368:Aged; D000553:Ambulatory Care; D005260:Female; D016330:Frail Elderly / Q000523:psychology; D015577:Geriatric Assessment; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006757:Hospital Units; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D011788:Quality of Life; D015996:Survival Rate