A Comparison of Placement Outcomes of Geriatric Cohorts Receiving Care in a Geriatric Assessment Unit and on General Medicine Floors

Abstract

To assess whether care in a geriatric assessment unit using a multidisciplinary team approach with rehabilitative emphasis impacted on patient placement outcomes, a historical prospective study was initiated using records of geriatric assessment unit patients admitted during a one-year period (n = 62). A second, diagnostically similar general medicine unit cohort was also sampled (n = 62). Placement outcomes of the two groups were compared. All study patients were 75 years of age or older, stratified by source of admission, and controlled for comparability using diagnostic grouping. The geriatric assessment unit admitted 92 per cent of its patients from home; the general medicine unit, 82 per cent. As a result of expanded rehabilitative, respite, and terminal care promoted by the geriatric assessment unit staff, mean length of stay was 36 days, whereas it was 13 days in the general medicine unit (P less than 0.001). There was no significant difference between the two units with respect to hospital deaths, post-hospitalization discharges to home or nursing homes, or patient locations (home versus nursing home) six months after admission. Although improvements in patient independence may have been achieved through the efforts of a multidisciplinary team approach utilizing the geriatric assessment unit, they were not sufficient to significantly increase the proportion of patients placed at home. Superiority in placement outcome may be demonstrated only by geriatric assessment unit use of selective admission criteria.

Geriatric Inpatient Units in the Care of Hospitalized Frail Adults with a History of Heart Failure

“…Improvement in physical function and reduced disability in older adults with HF at the time of hospital discharge may be functional biomarkers that could be associated with better outcomes 6,7 . Absence of sustained benefits using GEM, as observed in our study, has also been noted in previously published studies 8,9,28 and remains poorly understood. Although the downward spiral of the frailty syndrome was not attenuated over the long term after inpatient GEM in our study, it may be possible to reinforce inpatient GEM management strategies longitudinally in an effort to maintain functional reserves and adaptive capacity in older adults at high risk for clinical deterioration.…”

The Effect of Geriatrics Evaluation and Management on Nursing Home Use and Health Care Costs

“…One study whose primary aim was to assess patient placement outcomes found no significant difference in patient location (home vs. nursing home) at discharge or 6 months after admission between the geriatric assessment unit and usual care. 25 Rubenstein and colleagues found that patients assigned to the geriatric evaluation unit had a significant reduction in nursing home admissions at discharge but not at 12 months. 1 Several other studies found no significant difference between the GEM and usual care with regards to nursing home placement.…”

Discharge planning: issues and challenges for gerontological nursing. A critique of the literature

“…Applegate et al 1983, Cable & Mayers 1983, Teasdale et al 1983 Davies et al 1984, Victor & Vetter 1985, Waters 1987b, Saltz et al 1988 …”