Randomised trial of in-hospital geriatric intervention: impact on function and morale.
BACKGROUND
In two previous publications, we have shown that treatment of acutely sick, frail elderly patients in a Geriatric Evaluation and Management Unit (GEMU) compared to treatment in the general Medical Wards (MW) reduced mortality and improved the chances of living at home in contrast to living in nursing homes or being dead.


OBJECTIVE
The aim of this presentation was to study the impact on function, symptoms of depression and general well-being of treatment in the GEMU as compared to treatment in MW.


METHODS
Acutely sick, frail patients aged >or=75 years, admitted as emergencies to the Department of Internal Medicine, were randomised either to treatment in the GEMU (n = 127) or the MW (n = 127). In the GEMU the treatment strategy emphasised comprehensive interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilisation, rehabilitation and discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow-up. Activities of daily living (ADL), instrumental ADL, cognitive function, symptoms of depression and general well-being were assessed 3, 6 and 12 months after discharge from hospital.


RESULTS
There was no difference in function, depression or general well-being in the GEMU as compared to the MW group. If the dead were included in the analysis at the highest ADL dependency level, there was better function in the GEMU group at 3 months (p = 0.03).


CONCLUSIONS
Treatment in the GEMU had no measurable beneficial impact on function, morale or symptoms of depression. Taken the previously shown mortality reduction into consideration an additional effect on function was less likely and the overall treatment effect was considered to be positive.
Saltvedt
Ingvild
I
Division of Internal Medicine, Section of Geriatrics, St. Olavs University Hospital, Trondheim, Norway. ingvild.saltvedt@medisin.ntnu.no
Jordhøy
Marit
M
Opdahl Mo
Ellen-Sofie
ES
Fayers
Peter
P
Kaasa
Stein
S
Sletvold
Olav
O
D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000517:prevention & control; D004434:Early Ambulation; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D008297:Male; D009013:Morale; D009664:Norway; D010346:Patient Care Management; D016896:Treatment Outcome