BACKGROUND: The long-term efficacy of interdisciplinary outpatient primary
care Geriatric Evaluation and Management (GEM) has not been proven. This ar
ticle focuses on results obtained during the 2 years of the study.
METHODS: In this 2-year randomized clinical trial, at the Veterans Affairs
Medical Center, Memphis, TN, 128 veterans, age 65 years and older, were ran
domized to outpatient GEM or usual care (UC). Two-year follow-up analyses a
re based on the 98 surviving individuals. Study outcome measurements includ
ed health status, function, and quality of life including affect, cognition
, and mortality.
RESULTS: At 2 years, there were positive intervention effects for eight of
11 outcome measures, five of which had attained significance at 1 year. GEM
subjects, compared with UC subjects, had significantly greater improvement
in health perception (P = .001), smaller increases in numbers of clinic vi
sits (P = .019) and instrumental activities of daily living (IADL) impairme
nts (P = .006), improved social activity (P < .001), greater improvement in
Center for Epidemiologic Studies-Depression (CES-D) scores (P = .003), gen
eral wellbeing (P = .001), life satisfaction (P < .001), and Mini Mental St
ate Exam (MMSE) scores (P = .025). There were no significant treatment effe
cts in activities of daily living (ADL) scores (P = .386), number of hospit
alizations (P = .377), or mortality (P = .155).
CONCLUSIONS: These findings suggest that a primary care approach that combi
nes an initial interdisciplinary comprehensive assessment with long-term, i
nterdisciplinary outpatient management may improve outcomes for targeted ol
der adults significantly. Findings suggest further that outcomes may contin
ue to improve over time and that the GEM care model provides an effective w
ay to manage health care of older adults.