A Prospective Controlled Trial of a Geriatric Consultation Team in an Acute-care Hospital DAVID B. HOGAN, ROY A. FOX
Introduction Geriatric medicine is developing at a time when cost-effectiveness is emphasized, but, as Rubenstein [1] has pointed out, geriatric medicine is unique in feeling compelled to justify its consultative activities. Geriatric consultation services differ from traditional physician-tophysician consultations by: 1. Incorporating an interdisciplinary team approach in assessment and treatment 2. Emphasizing difficulties in activities of daily living, impaired mobility, urinary or faecal incontinence, psychosocial difficulties and discharge planning 3. Requesting changes in the behaviour of physicians and nurses towards the patient rather than simply suggesting a diagnostic study or altering medications.
Studies of the efficacy of geriatric consultation services have produced varying results [2-12]. Benefits reported have included improved short-term survival [12], decreased length of hospital stay [3, 7], decreased reliance on nursing-home care on discharge [3], and improved diagnostic accuracy [6]. Other studies [2, 8-11] have not identified such favourable outcomes. These differences could be due to variations in methods of evaluation, differing service team composition or function, and to selection of patients. Possibly the last is most critical; the 'positive' studies were distinguished by efforts to focus interventions on specified groups of elderly patients [3, 7, 12]. There is, however, no consensus on the most appropriate method of focusing interventions. Functional status is often a more important determinant of patient outcome than is admitting diagnosis [13] and Age and Ageing 1990;19:107-11 3
Downloaded from http://ageing.oxfordjournals.org/ at The Australian National University on June 5, 2016
Summary Attempts to prove the usefulness of geriatric consultation teams (GCT) in acute-care settings have been inconclusive. We have completed a prospective, controlled trial of a G C T in an acute-care setting, aiming our interventions at a specific subgroup of elderly patients. One hundred and thirty-two out of 352 (37.5%) patients met the inclusion criteria with 66 each being assigned to the intervention and the control groups. There were no significant differences in baseline characteristics between the two groups. Patients in the intervention group received follow-up after discharge from hospital by the geriatric service. We found that the intervention was associated with improved 6-month survival (p < 0.01), improved Barthel Index at 1 year (p
Introduction Geriatric medicine is developing at a time when cost-effectiveness is emphasized, but, as Rubenstein [1] has pointed out, geriatric medicine is unique in feeling compelled to justify its consultative activities. Geriatric consultation services differ from traditional physician-tophysician consultations by: 1. Incorporating an interdisciplinary team approach in assessment and treatment 2. Emphasizing difficulties in activities of daily living, impaired mobility, urinary or faecal incontinence, psychosocial difficulties and discharge planning 3. Requesting changes in the behaviour of physicians and nurses towards the patient rather than simply suggesting a diagnostic study or altering medications.
Studies of the efficacy of geriatric consultation services have produced varying results [2-12]. Benefits reported have included improved short-term survival [12], decreased length of hospital stay [3, 7], decreased reliance on nursing-home care on discharge [3], and improved diagnostic accuracy [6]. Other studies [2, 8-11] have not identified such favourable outcomes. These differences could be due to variations in methods of evaluation, differing service team composition or function, and to selection of patients. Possibly the last is most critical; the 'positive' studies were distinguished by efforts to focus interventions on specified groups of elderly patients [3, 7, 12]. There is, however, no consensus on the most appropriate method of focusing interventions. Functional status is often a more important determinant of patient outcome than is admitting diagnosis [13] and Age and Ageing 1990;19:107-11 3
Downloaded from http://ageing.oxfordjournals.org/ at The Australian National University on June 5, 2016
Summary Attempts to prove the usefulness of geriatric consultation teams (GCT) in acute-care settings have been inconclusive. We have completed a prospective, controlled trial of a G C T in an acute-care setting, aiming our interventions at a specific subgroup of elderly patients. One hundred and thirty-two out of 352 (37.5%) patients met the inclusion criteria with 66 each being assigned to the intervention and the control groups. There were no significant differences in baseline characteristics between the two groups. Patients in the intervention group received follow-up after discharge from hospital by the geriatric service. We found that the intervention was associated with improved 6-month survival (p < 0.01), improved Barthel Index at 1 year (p
