title: Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months.
abstract: OBJECTIVE
  To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion.
  
  
  METHODS
  Randomized, controlled, assessor-blinded, single-center trial.
  
  
  METHODS
  A geriatric ambulatory unit in a municipality in the southeast of Sweden.
  
  
  METHODS
  Community-dwelling individuals aged ≥ 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG).
  
  
  METHODS
  Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care.
  
  
  METHODS
  Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months.
  
  
  RESULTS
  Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P = .026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P = .01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P = .43).
  
  
  CONCLUSIONS
  CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGA's superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Department of Research and Education, Helsingborg Hospital, Helsingborg, Skåne Region, Sweden. Electronic address: anneekdahl@gmail.com.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Ekdahl
authors.affiliation: Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden.
authors.forename: Jenny
authors.initials: J
authors.lastname: Alwin
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Eckerblad
authors.affiliation: Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Husberg
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Department of Geriatric Medicine, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Amelie Lindh
authors.initials: AL
authors.lastname: Mazya
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Advanced Home Care and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Milberg
authors.affiliation: Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden.
authors.forename: Barbro
authors.initials: B
authors.lastname: Krevers
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Mitra
authors.initials: M
authors.lastname: Unosson
authors.affiliation: Department of Analysis of Health Care, Östergötland Region, Linköping, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wiklund
authors.affiliation: Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Carlsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics* / Q000592:standards*; D003365:Costs and Cost Analysis; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D016037:Single-Blind Method; D013548:Sweden
keywords: Comprehensive Geriatric Assessment; hospitalizations; mortality; outpatient geriatric care; total costs of care