A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations

BACKGROUND: Although comprehensive geriatric assessment (CGA) has been demo nstrated to confer health benefits in some settings, its value in outpatien t or office settings is uncertain. OBJECTIVE: To assess the effectiveness of outpatient CGA consultation coupl ed with an adherence intervention on 15-month health outcomes. DESIGN: A randomized controlled trial. SETTING: Community-based sites. PATIENTS: 363 community-dwelling older persons who had failed a screen for at least one of four conditions (falls, urinary incontinence, depressive sy mptoms, or functional impairment) INTERVENTION: A single outpatient CGA consultation coupled with an interven tion to improve primary care physician and patient adherence with CGA recom mendations. MEASUREMENTS: Medical Outcomes Study Short Form-36 (MOS SF-36), restricted activity and bed days, Physical Perfomance Test, NIA lower-extremity batter y. RESULTS: In complete case analysis (excluding the five control group subjec ts who died during the follow-up period), the adjusted difference in change scores (4.69 points) for physical functioning between treatment and contro l groups indicated a significant benefit of treatment (P = .021). Similar b enefits were demonstrated for number of restricted activity days and MOS SF -36 energy/fatigue, social functioning, and physical health summary scales. In analyses assigning scares of 0 to those who died, these benefits were g reater, and significant benefits for the Physical Performance Test and MOS SF-36 emotional/well being, pain, and mental health summary scales were als o demonstrated. CONCLUSIONS: A single outpatient comprehensive geriatric assessment coupled with an adherence intervention can prevent functional and health-related q uality-of-life decline among community-dwelling older persons who have spec ific geriatric conditions.