POSTDISCHARGE GERIATRIC ASSESSMENT OF HOSPITALIZED FRAIL ELDERLY PATIENTS

Background: The diffusion of comprehensive geriatric assessment servic es has been rather limited in North America partly because of reimburs ement and organizational constraints. Objective: To evaluate the impac t of a comprehensive geriatric assessment intervention for frail older patients that is started before hospital discharge and is continued a t home. Methods: Patients older than 65 years were selected who had ei ther unstable medical problems, recent functional limitations, or pote ntially reversible geriatric clinical problems. Patients (n=354) were randomly assigned to either the intervention group or a control group. Information on survival, readmissions, nursing home placement, medica tion use, and health status was collected at 30 and 60 days after hosp ital discharge. Results: No differences were observed between the two treatment groups in survival, hospital readmission, or nursing home pl acement by 60 days. After adjustment for baseline characteristics, no significant differences were observed between the two groups on measur es of physical functioning, social functioning, role limitations, heal th perceptions, pain, mental health, energy and/or fatigue, health cha nge, or overall well-being. Conclusions: Although efficacy has been de monstrated for some forms of comprehensive geriatric assessment, the t ypes of services that are easier to establish (inpatient consultation services and ambulatory assessment) have not been shown. to improve ou tcomes. Our results indicate that outcomes are unaffected by a limited form of comprehensive geriatric assessment begun in the hospital and completed at home. Further efforts are needed to develop and to evalua te realistic approaches to comprehensive geriatric assessment.