Interdisciplinary geriatric primary care evaluation and management: Two-year outcomes

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.