Geriatrician-performed comprehensive geriatric care in older adults referred to a community rehabilitation unit: A randomized controlled trial

Ding²,

et al. 2021

BMC Geriatr

Background Comprehensive geriatric assessment (CGA) interventions can improve functional ability and reduce mortality in older adults, but the effectiveness of CGA intervention on the quality of life, caregiver burden, and length of hospital stay remains unclear. The study aimed to determine the effectiveness of CGA intervention on the quality of life, length of hospital stay, and caregiver burden in older adults by conducting meta-analyses of randomised controlled trials (RCTs). Methods A literature search in PubMed, Embase, and Cochrane Library was conducted for papers published before February 29, 2020, based on inclusion criteria. Standardised mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs) was calculated using the random-effects model. Subgroup analyses, sensitivity analyses, and publication bias analyses were also conducted. Results A total of 28 RCTs were included. Overall, the intervention components common in different CGA intervention models were interdisciplinary assessments and team meetings. Meta-analyses showed that CGA interventions improved the quality of life of older people (SMD = 0.12; 95% CI = 0.03 to 0.21; P = 0.009) compared to usual care, and subgroup analyses showed that CGA interventions improved the quality of life only in participants’ age > 80 years and at follow-up ≤3 months. The change value of quality of life in the CGA intervention group was better than that in the usual care group on six dimensions of the 36-Item Short-Form Health Survey questionnaire (SF-36). Also, compared to usual care, the CGA intervention reduced the caregiver burden (SMD = − 0.56; 95% CI = − 0.97 to − 0.15, P = 0.007), but had no significant effect on the length of hospital stay. Conclusions CGA intervention was effective in improving the quality of life and reducing caregiver burden, but did not affect the length of hospital stay. It is recommended that future studies apply the SF-36 to evaluate the impact of CGA interventions on the quality of life and provide supportive strategies for caregivers as an essential part of the CGA intervention, to find additional benefits of CGA interventions.

Section: Resultsmentioning

confidence: 99%

Effectiveness of comprehensive geriatric assessment intervention on quality of life, caregiver burden and length of hospital stay: a systematic review and meta-analysis of randomised controlled trials

Ding²,

et al. 2021

BMC Geriatr

J American Geriatrics Society

“…A need also exists for studies with larger sample sizes and greater involvement of older patients with co‐morbidities including cognitive impairment, as these patients have historically been understudied/excluded from participation in similar studies 3,11,32–34 . Our study addressed these gaps and also demonstrated that geriatrician performed comprehensive care for older adults has positive outcomes in a rehabilitation setting 8,23,35 …”

Section: Discussionmentioning

confidence: 81%

“…The main goal of geriatric rehabilitation programs is to optimize the functional independence of their patients 20,21 . Furthermore, older adults treated by geriatricians are known to achieve better patient and system outcomes 21–24 . Hence, we designed an intervention to determine if we could more effectively improve on the resulting functional independence, lengths of stay, and quality of care of older rehabilitation patients through the introduction of a geriatric medicine service into an existing geriatric rehabilitation program that served both older dialysis and non‐dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Quality improvement outcomes from the introduction of a geriatrician into a rehabilitation setting

Fitzgerald

Norman

Sinha

et al. 2021

Objectives Geriatrician impact on patient and system outcomes in formal rehabilitation settings has not been well described to date. We studied the effect of adding a geriatric medicine consultation service to a geriatric focused rehabilitation setting providing care to dialysis and non‐dialysis patients. Design/setting/participants A pre‐ and post‐retrospective observational cohort study from January 1, 2009 to June 30, 2019 on all consecutively admitted adults aged 65 and older to general rehabilitation program, and adults aged 60 and older to specialized dialysis rehabilitation program, within a 25 bed general rehabilitation unit in a large urban academic rehabilitation center in Toronto, Ontario. Data were analyzed with quality improvement methodology including Statistical Process Control charts (XmR and U charts). Intervention Addition of a geriatric medicine service providing automatic comprehensive geriatric assessment and co‐management consultative services for all admitted patients from admission onwards who met criteria for the intervention. The intervention commenced on August 1, 2013. Measurements Outcome measures were length of stay (days), service interruption frequency, and average functional independence measure (FIM) change (discharge FIM minus admission FIM) which uses the validated FIM score, a marker of functional ability. A 22 point change in FIM score is clinically relevant. Results Patient characteristics: general rehabilitation patients (n = 1395, mean age = 79.7, 50.1% female) and dialysis rehabilitation patients (n = 838, mean age = 72.8, 41.8% female). The average FIM change following intervention improved from 20.8 to 29.3 in the general rehabilitation cohort (40.6% improvement, SD = 5.51) and from 22.1 to 30.6 in the dialysis rehabilitation cohort (38.6% improvement, SD = 5.88). Changes in length of stay (24.9%–28.1% reduction) and service interruption frequency (34.3%–49.7% reduction) were also observed. Conclusion Introduction of a geriatric medicine service for rehabilitation inpatients was associated with significant FIM score improvements. Our results suggest this intervention contributes to important gains in functional independence in reduced time for older adults receiving inpatient rehabilitative care.

“…However, the study did not explore 30-day readmission rates specifically and the negative result may be due to a spill over effect, that is, the intervention may have affected the control group, and a non-real-life setting since the intervention was performed by a single geriatrician only. 19 …”

Section: Discussionmentioning

confidence: 99%

“…The study sample size was calculated from expected change in readmission rate ‘before and after’. The inclusion of 367 patients in each group would give the study 80% power to detect a 30% reduction in readmission rate assuming a baseline readmission rate of 30%, 19 with a level of significance of 5%. This power calculation was used to define the length of the study period in order to ensure an adequate sample size.…”

Section: Methodsmentioning

confidence: 99%

Does geriatric follow-up visits reduce hospital readmission among older patients discharged to temporary care at a skilled nursing facility: a before-and-after cohort study

et al. 2021

IntroductionHospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes.ObjectiveWe aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF).DesignA retrospective single-centre before-and-after cohort study.Setting and participantsStudy population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016–25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed.InterventionOGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (−OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT).Main outcome measuresUnplanned hospital readmission between 4 hours and 30 days following initial discharge.ResultsTotally 847 patients were included (440 −OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in −OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with –OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period.ConclusionFollow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.