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.