A Consultation Service in Geriatric Medicine at a University Hospital

Eighty-one geriatric consultations conducted on behalf of 71 patients (mean patient age 78 years, range 59-99; M34 , F37 ) at San Francisco General Hospital were analyzed. Seventy-nine per cent of requests were for medical or psychiatric evaluation; 19 per cent social; and 3 per cent rehabilitation. The authors made 50 new diagnoses, many of which identified conditions that adversely affected patients' functional levels, including cardiovascular disorders (8), medication effects (8), malnutrition (7), misdiagnosis of dementia (7), and gait disorders (4). Recommendations focused on treating those conditions whose alleviation could improve self-care ability: medication adjustment (62 per cent), management of dementia, delirium, or depression (59 per cent), rehabilitation (32 per cent), and treatment of malnutrition (30 per cent). Geriatric consultations resulted in rerouting 18 patients (51 per cent) from nursing homes to lower levels of care. Fourteen of these eventually returned home. By focusing on reversible conditions that affect patients' functional levels, geriatric consultation can improve the management of elderly patients and prevent unnecessary nursing home placement.

Section: Discussionsupporting

confidence: 84%

Geriatric Consultation: A Functional Approach

Lichtenstein¹,

Winograd²

1984

“…Geriatric consultation services are emerging in numerous acute‐care teaching hospitals as logical, perhaps inevitable, services for clinical geriatrics departments to provide. Although there exist several detailed descriptions of geriatric consultation services in the United States and abroad, 4–7 this pilot study describes a controlled trial of a geriatric consultation service to assess its effect on the care actually received by elderly patients and on subsequent outcomes. The failure of this service to have any impact on the rate of patient readmission is disappointing and must temper our hopes that the presence of energetic and idealistic geriatric consultants will resolve the complex problems of the hospitalized elderly.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of this strategy include low start‐up costs, the opportunity to intervene at the time of patients’ acute need, high visibility in the teaching setting, and professional acceptance of the respected role of consultant. To date there have been only scattered descriptions of such geriatric consultation services and, as far as we know, no controlled studies of their effect on patient care 4–7 . The current study describes the structure and function of an interdisciplinary Geriatric Consultation Team (GCT) introduced initially in one medical unit at the Massachusetts General Hospital (MGH).…”

mentioning

confidence: 99%

An Interdisciplinary Geriatric Consultation Service: A Controlled Trial

Campion

Jette

Berkman

1983

The structure and function of a newly created interdisciplinary Geriatric Consultation Team (GCT) are described. The GCT was introduced on a single medical unit, where consultations were given to 46 consecutive patients aged 75 years and over. The GCT patients had, on the average, 5.5 illnesses and were receiving 3.7 medications. Anemia (50 per cent), were hypoalbuminemia (65 per cent), and elevated blood urea nitrogen (BUN) (58 per cent) were frequent. Functional assessment showed frequent dependence on others for assistance with ambulation (59 per cent), transfers (54 per cent), and dressing (52 per cent); cognitive impairment was found in 52 per cent and clinical depression in 11 per cent of the patients. In comparison with control units, the GCT increased use of physical therapy by 357 per cent, occupational therapy by 390 per cent, and speech therapy by 300 per cent without increasing length of stay. In comparison with control subjects, GCT patients had no decrease in hospital readmission rates (43 per cent) over 10.5 months of follow up. It was concluded that a GCT in an acute-care hospital promotes geriatrics, teaches interdisciplinary teamwork, improves awareness of functional problems of patients, and increases use of rehabilitative services, but does not decrease the high rate of readmission of hospitalized geriatric patients.

“…Provide follow-up of patients and emphasize continuity of care of patients who might otherwise be disregarded, e.g., patients discharged to a home care program or to a long-term care facility. 10. Provide an arena for validating the work that staff is doing on behalf of patients.…”

Section: Formul Componentsmentioning

confidence: 99%

The Geriatric Team in the Acute Care Hospital: An Educational and Consultation Modality

Blumenfield¹,

Morris²,

Sherman³

1982

Increasing numbers of older patients with acute, subacute, rehabilitative, and chronic problems are being cared for in acute care hospitals. Health care professionals working in the acute care hospital have not had the training necessary to deal with this particular population. This article discusses the conception and implementation of a multidisciplinary educational and consultation team on an acute care medical unit in an academic medical center.