A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients

Objective: to prove the effectiveness of geriatric evaluation and managemen t for elderly, hospitalized patients, combined with post-discharge home int ervention by an interdisciplinary team. Design: randomized controlled trial with outcome and costs assessed for 12 months after the date of admission. Setting: university-affiliated geriatric hospital and the homes of elderly patients. Subjects: 545 patients with acute illnesses admitted from home to the geria tric hospital. Interventions: patients were randomly assigned to receive either comprehens ive geriatric assessment and postdischarge home intervention (intervention) , comprehensive geriatric assessment alone (assessment) or usual care (cont rol). Main outcome measures: survival, functional status, rehospitalization, nurs ing home placement and direct costs over 12 months. Results: the intervention group showed a significant reduction in length of hospital stay (33.49 days vs 40.7 days in the assessment group and 42.7 da ys in the control group; P < 0.05) and rate of immediate nursing home place ment (4.4% vs 7.3% and 8.1%; P < 0.05). There was no difference in survival , acute care hospital readmissions or new admissions to nursing homes but t he intervention group had significantly shorter hospital readmissions (22.2 days vs 34.2 days and 35.7 days; P < 0.05) and nursing home placements (11 4.7 days vs 161.6 days and 170.0 days; P < 0.05). Direct costs were lower i n the intervention group [about DM 7000 (US $4000) per person per year]. Fu nctional capacities were significantly better in the intervention group. Conclusions: comprehensive geriatric assessment in combination with post-di scharge home intervention does not improve survival, but does improve funct ional status and can reduce the length of the initial hospital stay and of subsequent readmissions. It can reduce the rate of immediate nursing home a dmissions and delay permanent nursing home placement. It may also substanti ally reduce direct costs of hospitalized patients.