title: Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
abstract: OBJECTIVE
  The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit.
  
  
  METHODS
  This is a clinical, prospective, randomized, controlled, one-center intervention study.
  
  
  METHODS
  This study was conducted in a large county hospital in western Sweden.
  
  
  METHODS
  The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female.
  
  
  METHODS
  This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit.
  
  
  METHODS
  The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs.
  
  
  RESULTS
  After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14-0.79), ambulation (OR =0.19, 95% CI =0.1-0.37), dexterity (OR =0.38, 95% CI =0.19-0.75), emotion (OR =0.43, 95% CI =0.22-0.84), cognition (OR = 0.076, 95% CI =0.033-0.18) and pain (OR =0.28, 95% CI =0.15-0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32-0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05).
  
  
  CONCLUSIONS
  Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost.
authors.affiliation: Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhattan; Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping.
authors.forename: Niklas
authors.initials: N
authors.lastname: Ekerstad
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine.
authors.forename: Björn W
authors.initials: BW
authors.lastname: Karlson
authors.affiliation: Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation.
authors.forename: Synneve
authors.initials: S
authors.lastname: Dahlin Ivanoff
authors.affiliation: Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
authors.forename: Sten
authors.initials: S
authors.lastname: Landahl
authors.affiliation: Division of Economics, Department of Management and Engineering, Linköping University, Linköping.
authors.forename: David
authors.initials: D
authors.lastname: Andersson
authors.affiliation: Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Emelie
authors.initials: E
authors.lastname: Heintz
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping.
authors.forename: Magnus
authors.initials: M
authors.lastname: Husberg
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping.
authors.forename: Jenny
authors.initials: J
authors.lastname: Alwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000458:organization & administration* / Q000706:statistics & numerical data; D006739:Hospital Administration; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D013548:Sweden
keywords: acute care; comprehensive geriatric assessment; elderly; frailty; intervention