Journal Article

Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

Karlson, Björn, Husberg, Magnus, Ekerstad, Niklas, Alwin, Jenny, Heintz, Emelie, Landahl, Sten, Dahlin Ivanoff, Synneve, Andersson, David

2017

Overview

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. This is a clinical, prospective, randomized, controlled, one-center intervention study. This study was conducted in a large county hospital in western Sweden. 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. This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. 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. 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 ( >0.05). 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.

• Publisher: Dove Medical Press Limited,Taylor & Francis Ltd,Dove Press,Dove Medical Press
• Subject: acute care / Aged / Aged, 80 and over / Care and treatment / Chronic illnesses / Clinical Medicine / Cognition / Comorbidity / Comparative analysis / comprehensive geriatric assessment / elderly / Emergency medical care / Female / Frail Elderly / Frailty / Geriatric Assessment / Geriatrics / Health aspects / Health care policy / Health Sciences / Health Services for the Aged - organization & administration / Health Services for the Aged - statistics & numerical data / Hospital Administration / Hospitals / Humans / Hälsovetenskap / Interdisciplinary aspects / intervention / Klinisk medicin / Male / Medical examination / Mortality / Odds Ratio / Older people / Original Research / Patient care / Patient Discharge / Patient outcomes / Patients / Physiology / Proportional Hazards Models / Prospective Studies / Quality of Life / R&D / Rehabilitation / Research & development / Sweden