A Randomized, Controlled Trial of a Geriatric Assessment Unit in a Community Rehabilitation Hospital

Abstract

We conducted a randomized trial in a community rehabilitation hospital to determine the effect of treatment in a geriatric assessment unit on the physical function, institutionalization rate, and mortality of elderly patients. Functionally impaired elderly patients (mean age, 78.8 years) who were recovering from acute medical or surgical illnesses and were considered at risk for nursing home placement were randomly assigned either to the geriatric assessment unit (n = 78) or to a control group that received usual care (n = 77). The two groups were similar at entry and were stratified according to the perceived risk of an immediate nursing home placement. After six months, the patients treated in the geriatric assessment unit had significantly more functional improvement in three of eight basic self-care activities (P less than 0.05). Those in the lower-risk stratum had significantly more improvement in seven of eight self-care activities. Both six weeks and six months after randomization, significantly more patients treated in the geriatric assessment unit than controls (79 vs. 61 percent after six months) were residing in the community. During the year of follow-up, the control patients had more nursing home stays of six months or longer (10 vs. 3; P less than 0.05). However, there was no difference between the groups in the mean number of days spent in health care facilities (acute care hospital, nursing home, or rehabilitation hospital). Survival analysis showed a trend toward fewer deaths among the patients treated in the geriatric assessment unit, and mortality was significantly reduced in the patients considered to be at lower risk of immediate nursing home placement (P less than 0.05). We conclude that the treatment of selected elderly patients in a specialized geriatric rehabilitation unit improves function, decreases the risk of nursing home placement, and may reduce mortality. The beneficial effects on mortality and function appear greatest for patients at a moderate rather than high risk of nursing home placement.

Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with Parkinsons disease

“…PADRECC is an integrated healthcare delivery model that uses a multidisciplinary assessment and management approach to PD. Both the VHA and the civilian sector have successfully implemented multidisciplinary approaches in the management of specific conditions, including amputation [1], age-related conditions [2][3], traumatic brain injury [4][5], diabetes mellitus [6], and stroke [7]. This investigation expands on an earlier study that assessed the impact of PADRECC multidisciplinary care on individuals with PD at 1-year follow-up [8].…”

Frailty in Older Adults: Evidence for a Phenotype

“…Numerous geriatric interventions have been developed to improve clinical outcomes for frail older adults (3)(4)(5)(6)(7). A major obstacle to the success of such interventions has been the absence of a standardized and valid method for screening of those who are truly frail so as to effectively target care (1,3).…”

A new future for hip fracture care – orthogeriatrician lead in an ‘Acute’ Hip Unit

“…Randomised trial data show that geriatric rehabilitation programs increase the likelihood of patients returning to the community. 32 The relationship between rehabilitation program and functional gain in patients with cognitive impairment is complex. A systematic review showed benefi cial effects of a rehabilitation programme on physical function in cognitively impaired patients, 33 hence rehabilitation after hip fracture is mandatory even for cognitively impaired patients.…”