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Randomized Controlled Trial
. 2013 Oct 8:347:f5874.
doi: 10.1136/bmj.f5874.

Specialist geriatric medical assessment for patients discharged from hospital acute assessment units: randomised controlled trial

Judi Edmans  1 , Lucy Bradshaw, Matthew Franklin, John Gladman, Simon Conroy
Affiliations
Randomized Controlled Trial

Specialist geriatric medical assessment for patients discharged from hospital acute assessment units: randomised controlled trial

Judi Edmans et al. BMJ. .

Abstract

Objective: To evaluate the effect of specialist geriatric medical management on the outcomes of at risk older people discharged from acute medical assessment units.

Design: Individual patient randomised controlled trial comparing intervention with usual care.

Setting: Two hospitals in Nottingham and Leicester, UK.

Participants: 433 patients aged 70 or over who were discharged within 72 hours of attending an acute medical assessment unit and at risk of decline as indicated by a score of at least 2 on the Identification of Seniors At Risk tool.

Intervention: Assessment made on the acute medical assessment unit and further outpatient management by specialist physicians in geriatric medicine, including advice and support to primary care services.

Main outcome measures: The primary outcome was 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) in the 90 days after randomisation. Secondary outcomes were determined at 90 days and included mortality, institutionalisation, dependency, mental wellbeing, quality of life, and health and social care resource use.

Results: The two groups were well matched for baseline characteristics, and withdrawal rates were similar in both groups (5%). Mean days at home over 90 days' follow-up were 80.2 days in the control group and 79.7 in the intervention group. The 95% confidence interval for the difference in means was -4.6 to 3.6 days (P=0.31). No significant differences were found for any of the secondary outcomes.

Conclusions: This specialist geriatric medical intervention applied to an at risk population of older people attending and being discharged from acute medical units had no effect on patients' outcomes or subsequent use of secondary care or long term care.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Overall outline of randomised controlled trial of comprehensive geriatric assessment intervention
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Fig 2 Flow chart of study. GHQ=General Health Questionnaire; ICECAP-O=ICEpop CAPability measure for older people
See this image and copyright information in PMC

References

    1. Percival F, Day N, Lambourne A, Derek B, Ward D. An evaluation of consultant input into acute medical admissions management in England, Wales and Northern Ireland. Royal College of Physicians, 2010.
    1. Woodard J, Gladman J, Conroy S. Frail older people at the interface. Age Ageing 2010;39(S1):i36.
    1. Edmans J, Bradshaw L, Gladman J, Franklin M, Berdunov V, Elliott RA, et al. The Identification of Seniors at Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units. Age Ageing 2013; published online 10 May. - PMC - PubMed
    1. Woodard J, Rowell G, Vartha R, Whittingham C, Vadher N, Conroy S. Appropriate prescribing in older people. J Nutr Health Aging 2009;13(suppl 1):S477.
    1. Gladman J, Kearney F, Ali A, Blundell A, Wong R, Laithwaite E, et al. The role of the interface geriatrician across the acute medical unit / community interface. Medical Crises in Older People. Discussion Paper Series Issue 9 February 2012. (available at http://nottingham.ac.uk/mcop/documents/papers/issue9-mcop-issn2044-4230.pdf).

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