Effectiveness of three types of geriatric medical services: lessons for geriatric psychiatric services

Abstract

Objectives: To determine the effectiveness of geriatric medical services, to identify the types of patients who would benefit from such services, to determine the service components related to positive outcomes and to apply pertinent findings to geriatric psychiatric services.

Data sources: Two databases, MEDLINE and Health Planning and Administration, were searched for relevant articles published from January 1975 to February 1990. The bibliographies of identified articles were searched for additional references.

Study selection: Seventeen reports were located that met the following three inclusion criteria: original research, published in English or French and controlled trial (nonrandomized or randomized) of a geriatric medical service. Fifteen met the validity criteria for intervention studies established by McMaster University, Hamilton, Ont.

Data extraction: Information about study design, patient selection, interventions, outcome measures and results was systematically abstracted from each report.

Data synthesis: Abstracted data were compared and contrasted. Most of the external services and some of the hospital units were effective in reducing the number of hospital days an deaths. Consultation services were ineffective. Continuing care appeared to be related to positive outcomes.

Conclusion: In applying these findings to geriatric psychiatric services priority should be given to the development of external services and the organization of continuing care.