A MULTICENTER RANDOMIZED TRIAL OF COMPREHENSIVE GERIATRIC ASSESSMENT AND MANAGEMENT - EXPERIMENTAL-DESIGN, BASE-LINE DATA, AND 6-MONTH PRELIMINARY-RESULTS

Between October 1992 and July 1993, 11 Northern Italian geriatric depa rtments systematically screened 1386 inpatients hospitalized for at le ast 10 days. Of those screened, 74% (N=1019) were excluded by one or m ore of 7 exclusion criteria; 32% (N=118) of the 367 remaining subjects failed to meet more than 1 of 8 inclusion criteria. The 11 Geriatric Evaluation Units (GEUs) examined the remaining eligible 249 inpatients with a uniform comprehensive geriatric assessment (CGA) plan, which i ncluded a number of validated assessment scales. Of those evaluated, 3 9% (N=97) were ineligible for the study because of being unwilling, no ncompliant, too sick or ''not truly frail'', and the remaining 152 (11 % of all patients-screened) were randomly enrolled in two groups; 79 w ere assigned to the GEU (experimental group), and 73 to standard care in the National Health Care System (control group). At entry there tea s no statistically significant difference between the two groups. At 6 months, preliminary results are encouraging; GEU patients had a lower mortality than controls (2 vs 8, 2.5% vs 10.9%; p<0.05). Slight diffe rences were seen in both clinical-cognitive-affective-functional statu s and the use of health and social care resources. Only 3 subjects dro pped out, 8 refused further follow-up, and 3 went to a nursing-home. W e conclude that a standardized selection plan can recognize frail elde rly inpatients and that GEU care seems to achieve good results.