A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients.
BACKGROUND
the usefulness of geriatric evaluation and management (GEM) approaches in the care of frail elderly patients remains uncertain. We examined whether an inpatient geriatric consultation service might be beneficial in a country with a social welfare system.


METHODS
we conducted a randomised trial with 345 patients from five centres. Ninety additional patients from four separate centres without GEM teams served as an external comparison. All patients were hospitalised, at least 65 years and frail. Patients were randomly assigned to either comprehensive geriatric assessment and management in the form of consultations and follow-up or usual care. Primary outcomes were rehospitalisation and nursing home placement 1 year after randomisation. Secondary outcomes were survival, functional, emotional and cognitive status, social situation and quality of life.


RESULTS
at 12 months, the groups did not differ in the rate of rehospitalisation (intervention 67%, control 60%, P=0.30), nursing home placement (intervention 19%, control 14%, P=0.27), survival (intervention 81%, control 85%, P=0.56) or any of the other secondary measures. The external comparison groups were also similar in nursing home placement (16%, P=0.40), survival (80%, P=0.88) and all the secondary variables, but rehospitalisation was less (48%, P=0.04). No subgroup benefited from the intervention.


CONCLUSIONS
care provided by consultation teams did not improve the rates of rehospitalisation or nursing home placement. This is not due to carry-over effects of geriatric knowledge into the control group.
Kircher
Tilo T J
TT
Department of Psychiatry, University of Tübingen, Osianderstr. 24, D-72076 Tübingen, Germany. tkircher@ukaachen.de
Wormstall
Henning
H
Müller
Peter H
PH
Schwärzler
Frank
F
Buchkremer
Gerhard
G
Wild
Klaus
K
Hahn
Johannes-Martin
JM
Meisner
Christoph
C
D000369:Aged, 80 and over; D003071:Cognition; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D005858:Germany; D006299:Health Services for the Aged; D006801:Humans; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D008297:Male; D010347:Patient Care Planning; D010359:Patient Readmission; D011788:Quality of Life; D012017:Referral and Consultation; D012931:Social Environment; D012946:Social Welfare