Inpatient geriatric units and outpatient geriatric clinics improve quality of life, but not survival for frail older adults

Kominski, Professor Gerald F. PhD

UCLA School of Public Health; Los Angeles, USA

Abstracted from:Cohen H, Feussner J, Weinberger M, Carnes M, Hamdy R, Hsieh F, Phibbs C, Lavori P. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Eng J Medi 2002; 346: 905-912 .

Evidence-based Healthcare 6(4):p 146-147, December 2002.

BACKGROUND

Many multidisciplinary geriatric assessment programmes have been developed over the past two decades. The benefit of geriatric evaluation and management in inpatient units and outpatient clinics remains unclear.

OBJECTIVE

To assess the effect of inpatient and outpatient geriatric programmes on survival, functioning and quality of life among frail older adults.

SETTING

Eleven Veterans' Affairs medical centres in the United States; August 1995 to January 1999.

METHOD

Randomised trial.

PARTICIPANTS

Eleven hundred and eighty-eight frail hospitalised people aged over 65 years. People were considered frail if they had had a stroke in the past 3 months; were unable to perform basic activities of daily living or had a history of falls, dementia, depression or incontinence.

INTERVENTION

After their condition was stabilised, participants received care in an inpatient geriatric unit or usual inpatient care, followed by care in an outpatient geriatric clinic or usual outpatient care (2 × 2 factorial design).

OUTCOMES

Survival; health-related quality of life after 1 year.

MAIN RESULTS

On discharge, people treated in geriatric units had greater improvements in physical performance, activities of daily living and some quality of life scores compared to usual care. At 1 year, people who received geriatric outpatient treatment had better mental health scores than those who received usual care. There were no differences in costs or 1-year mortality among people who received inpatient geriatric care, outpatient geriatric care or usual care (Table 1). There were no synergistic effects between specialist inpatient and outpatient care.

Table 1 One-year survival among frail people aged over 65 years managed in specialist geriatric inpatient units, outpatient clinics or usual care
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AUTHORS' CONCLUSIONS

Although inpatient geriatric units and outpatient geriatric clinics reduce functional decline and improve mental health, they have no effect on survival among frail elderly people.

NOTES

The study did not reach the planned level of statistical power.