A Randomized, Controlled Trial of a Geriatric Assessment Unit in a Community Rehabilitation Hospital

作者：William B. Applegate, Stephen T. Miller, Marshall J. Graney, Janet T. Elam, Robert A. Burns, Derene E. Akins · 发表于：New England Journal of Medicine · 年份：1990 · DOI：10.1056/nejm199005313222205 · 被引用次数：434 · 研究领域：Frailty in Older Adults、Geriatric Care and Nursing Homes、Dementia and Cognitive Impairment Research

We conducted a randomized trial in a community rehabilitation hospital to determine the effect of treatment in a geriatric assessment unit on the physical function, institutionalization rate, and mortality of elderly patients. Functionally impaired elderly patients (mean age, 78.8 years) who were recovering from acute medical or surgical illnesses and were considered at risk for nursing home placement were randomly assigned either to the geriatric assessment unit (n = 78) or to a control group that received usual care (n = 77). The two groups were similar at entry and were stratified according to the perceived risk of an immediate nursing home placement. After six months, the patients treated in the geriatric assessment unit had significantly more functional improvement in three of eight basic self-care activities (P less than 0.05). Those in the lower-risk stratum had significantly more improvement in seven of eight self-care activities. Both six weeks and six months after randomization, significantly more patients treated in the geriatric assessment unit than controls (79 vs. 61 percent after six months) were residing in the community. During the year of follow-up, the control patients had more nursing home stays of six months or longer (10 vs. 3; P less than 0.05). However, there was no difference between the groups in the mean number of days spent in health care facilities (acute care hospital, nursing home, or rehabilitation hospital). Survival analysis showed a trend to...