OBJECTIVES: To measure the effects of outpatient geriatric evaluation and m
anagement (GEM) on high-risk older persons' functional ability and use of h
ealth services.
DESIGN: Randomized clinical trial.
SETTING: Ambulatory clinic in a community hospital.
PARTICIPANTS: A population-based sample of community-dwelling Medicare bene
ficiaries age 70 and older who were at high risk for hospital admission in
the future (N = 568).
INTERVENTION: Comprehensive assessment followed by interdisciplinary primar
y care.
MEASUREMENTS: Functional ability, restricted activity days, bed disability
days, depressive symptoms, mortality, Medicare payments, and use of health
services. Interviewers were blinded to participants' group status.
RESULTS: Intention-to-treat analysis showed that the experimental participa
nts were significantly less likely than the controls to lose functional abi
lity (adjusted odds ratio (aOR) = 0.67, 95% confidence interval (CI) = 0.47
-0.99), to experience increased health-related restrictions in their daily
activities (aOR = 0.60, 95% CI = 0.37-0.96), to have possible depression (a
OR = 0.44, 95% CI = 0.20-0.94), or to use home healthcare services (aOR = 0
.60, 95% CI = 0.37-0.92) during the 12 to 18 months after randomization. Mo
rtality, use of most health services, and total Medicare payments did not d
iffer significantly between the two groups. The intervention cost $1,350 pe
r person.
CONCLUSION: Targeted outpatient GEM slows functional decline.