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Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU NAL Uddevalla Hospital Grp, Sweden.
University of Gothenburg, Sweden.
University of Gothenburg, Sweden.
University of Gothenburg, Sweden.
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2017 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12Article in journal (Refereed) Published
Abstract [en]

Objective: 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. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged amp;gt;= 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. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: 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. Results: 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 (Pamp;gt;0.05). Conclusion: 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.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD , 2017. Vol. 12
Keyword [en]
frailty; elderly; acute care; intervention; comprehensive geriatric assessment
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:liu:diva-133878DOI: 10.2147/CIA.S124003ISI: 000390471100001PubMedID: 28031704OAI: oai:DiVA.org:liu-133878DiVA, id: diva2:1065126
Note

Funding Agencies|Health Care Subcommittee, Region Vastra Gotaland; Department of Research and Development, NU Hospital Group; Fyrbodal Research and Development Council, Region Vastra Gotaland, Sweden

Available from: 2017-01-13 Created: 2017-01-13 Last updated: 2018-04-18

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