A clinimetric evaluation of specialized geriatric care for rural dwelling,frail older people

OBJECTIVE: To test Comprehensive Geriatric Assessment (CGA) as an adjunct t o usual care. DESIGN: A randomized controlled trial with 3, 6, and 12 months follow-up. SETTING: Rural communities. PATIENTS: A total of 182 of 265 frail older patients (52 refused, 2 withdra wn, 27 ineligible, 2 deaths) referred by family practitioners with allocati on to intervention (n = 95) or usual care (n = 87). INTERVENTION: Three-month implementation of CGA recommendations by a Mobile Geriatric Assessment Team (MGAT) with follow-up assessments at 3, 6, and 1 2 months. Geriatric nurse assessors, blinded to group assignment, performed each assessment. MAIN OUTCOME MEASURE: Goal Attainment Scaling (GAS). RESULTS: Baseline characteristics were comparable between groups. At 3 mont hs, the intervention group was more likely to attain their goals (GAS total : (X) over bar = 46.4 +/- 5.9; GAS outcome (X) over bar = 48.0 +/- 6.6) com pared with controls (total: (X) over bar = 38.7 +/- 4.1; outcome (X) over b ar = 40.8 +/- 5.6) (P < .001). Standard assessments of function (Barthel in dex, instrumental activities of daily living), cognition (Mini-Mental State Examination), and quality of life (modified Spitzer quality of life index) showed no difference over 12 months. No difference in survival (interventi on: (X) over bar = 320 days, SE = 6; control: (X) over bar = 294 days, SE = 6; P = .257) or time to institutionalization (intervention: 340 days, SE = 9; control: 342 days, SE = 8; log rank = 0.661; P = .416) were observed. CONCLUSIONS: A MGAT can target rural dwelling, frail older persons, perform in-home CGA, and develop an intervention strategy. Although the interventi on did not prolong life or delay institutionalization, clinically important benefits were observed.