Acute medical unit comprehensive geriatric assessment intervention study (AMIGOS)

Abstract

Background: Many older people presenting to Acute Medical Units (AMU) are discharged after only a short stay (< 72 hours), yet many re-present to hospital or die within 1 year. Comprehensive Geriatric Assessment may improve patient outcomes for this group.

Participants: Patients aged > 70 years and scoring positive on a risk screening tool ('Identification of Seniors At Risk') who are discharged within 72 hours of attending an AMU with a medical crisis, recruited prior to discharge. Sample size is 400. Carers of participants will also be recruited.

Intervention: Assessment on the AMU and further out-patient management by a specialist physician in geriatric medicine. Assessment and further management will follow the principles of Comprehensive Geriatric Assessment, providing advice and support to primary care services.

Design: Multi-centre, individual patient randomised controlled trial comparing intervention with usual care.

Outcome measurement: Follow up is by postal questionnaire 90 days after randomisation, and data will be entered into the study database by a researcher blind to allocation. The primary outcome is the number of days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, health and social care resource use, and scaled outcome measures, including quality of life, disability, mental well-being. Carer strain and well being will also be measured at 90 days.

Analyses: Comparisons of outcomes and costs, and a cost utility analysis between the intervention and control groups will be carried out.

Trial registration: ISRCTN: ISRCTN21800480.

Figure 1

Overall study outline of a comprehensive geriatric assessment intervention randomised controlled trial. This illustrates the processes involved in a randomised controlled trial comparing comprehensive geriatrician assessment and intervention over current management for high risk older patients discharged from an acute medical unit.

Figure 2

Recruitment algorithm of a comprehensive geriatric assessment intervention randomised controlled trial. This figure illustrates the recruitment algorithm to be used depending upon the presence or absence of capacity to consent to the study, and the presence or absence of a carer.