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J Am Geriatr Soc. 2000 Sep;48(9):1080-5.

A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people.

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1
Division of Geriatric Medicine, Dalhousie University and Centre for Health Care of the Elderly, Halifax, Nova Scotia, Canada.

Abstract

OBJECTIVE:

To test Comprehensive Geriatric Assessment (CGA) as an adjunct to usual care.

DESIGN:

A randomized controlled trial with 3, 6, and 12 months follow-up.

SETTING:

Rural communities.

PATIENTS:

A total of 182 of 265 frail older patients (52 refused, 2 withdrawn, 27 ineligible, 2 deaths) referred by family practitioners with allocation to intervention (n = 95) or usual care (n = 87).

INTERVENTION:

Three-month implementation of CGA recommendations by a Mobile Geriatric Assessment Team (MGAT) with follow-up assessments at 3, 6, and 12 months. Geriatric nurse assessors, blinded to group assignment, performed each assessment.

MAIN OUTCOME MEASURE:

Goal Attainment Scaling (GAS).

RESULTS:

Baseline characteristics were comparable between groups. At 3 months, the intervention group was more likely to attain their goals (GAS total: chi = 46.4 +/- 5.9; GAS outcome chi = 48.0 +/- 6.6) compared with controls (total: chi = 38.7 +/- 4.1; outcome chi = 40.8 +/- 5.6) (P < .001). Standard assessments of function (Barthel index, instrumental activities of daily living), cognition (Mini-Mental State Examination), and quality of life (modified Spitzer quality of life index) showed no difference over 12 months. No difference in survival (intervention: chi = 320 days, SE = 6; control: chi = 294 days, SE = 6; P = .257) or time to institutionalization (intervention: 340 days, SE = 9; control: 342 days, SE = 8; log rank = 0.661; P = .416) were observed.

CONCLUSIONS:

A MGAT can target rural dwelling, frail older persons, perform in-home CGA, and develop an intervention strategy. Although the intervention did not prolong life or delay institutionalization, clinically important benefits were observed.

PMID:
10983907
[Indexed for MEDLINE]
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