Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Hea...

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Autores principales:	Ekerstad N, Karlson BW, Dahlin Ivanoff S, Landahl S, Andersson D, Heintz E, Husberg M, Alwin J
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	frailty elderly acute care intervention comprehensive geriatric assessment Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/b945ba6990d64e188f947cd694aaa70f
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spelling	oai:doaj.org-article:b945ba6990d64e188f947cd694aaa70f2021-12-02T05:24:59ZIs the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?1178-1998https://doaj.org/article/b945ba6990d64e188f947cd694aaa70f2016-12-01T00:00:00Zhttps://www.dovepress.com/is-the-acute-care-of-frail-elderly-patients-in-a--comprehensive-geriat-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost. Keywords: frailty, elderly, acute care, intervention, comprehensive geriatric assessmentEkerstad NKarlson BWDahlin Ivanoff SLandahl SAndersson DHeintz EHusberg MAlwin JDove Medical Pressarticlefrailtyelderlyacute careinterventioncomprehensive geriatric assessmentGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 12, Pp 1-9 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	frailty elderly acute care intervention comprehensive geriatric assessment Geriatrics RC952-954.6
spellingShingle	frailty elderly acute care intervention comprehensive geriatric assessment Geriatrics RC952-954.6 Ekerstad N Karlson BW Dahlin Ivanoff S Landahl S Andersson D Heintz E Husberg M Alwin J Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
description	Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost. Keywords: frailty, elderly, acute care, intervention, comprehensive geriatric assessment
format	article
author	Ekerstad N Karlson BW Dahlin Ivanoff S Landahl S Andersson D Heintz E Husberg M Alwin J
author_facet	Ekerstad N Karlson BW Dahlin Ivanoff S Landahl S Andersson D Heintz E Husberg M Alwin J
author_sort	Ekerstad N
title	Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
title_short	Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
title_full	Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
title_fullStr	Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
title_full_unstemmed	Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
title_sort	is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/b945ba6990d64e188f947cd694aaa70f
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Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

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