A randomized, controlled trial of a geriatric assessment unit in a community rehabilitation hospital

Article Abstract:

Inpatient geriatric assessment units are hospital units where older people undergo medical and social assessment and treatment, with an emphasis on rehabilitation. Since deterioration leading to institutionalization after illness or injury is a threat to these patients, it is possible that spending time in such an assessment unit could improve function and stave off institutionalization and even death. This hypothesis was tested by carrying out a controlled clinical study of 155 elderly patients (average age, approximately 79) who were recovering from acute medical or surgical illnesses. Patients were randomly assigned either to the geriatric assessment unit of a community rehabilitation hospital (78 patients) or to receive usual care as administered by their physicians. Risk of going to a nursing home was determined for each patient (high or low risk) before the patient was assigned to one of the treatment conditions. Patients were evaluated before group assignment, after six weeks, six months, and one year using the ADL (Activities of Daily Life) scale, which comprises eight items, such as walking, bathing, and eating. Results showed that patients assigned to the geriatric assessment unit improved more than control patients in three self-care activities during the earlier times studied, but at one year after treatment began, the groups were similar. Lower-risk patients showed more improvement in the unit than in the control situation. Living in an institution tended to be less common for patients who had been in the geriatric unit during the first six months, but there was no overall difference between in the number of days spent in health care facilities. Twenty-one percent of patients in the control group had died by the time of six months' follow-up, as compared with 10 percent of patients in the assessment unit group. There appeared to be a survival advantage to the assessment unit for low-risk patients, but not for high-risk patients. In general, results from studies of geriatric units' programs are conflicting; a discussion of the issue is provided. It appears that benefits from such services are greater for elderly patients with moderate, rather than severe, impairment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Hospitalization, Hospitals, Hospital care, Hospital rehabilitation services

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Geriatric medicine

Article Abstract:

New data indicate that mortality rates in the elderly actually decline as they age. For this reason and others, the number of elderly people will grow even faster than predicted. The goal of geriatric medicine is to reduce disability in the elderly and most of the disability is caused by chronic diseases such as cancer, cardiovascular disease, dementia and osteoarthritis. Several studies have assessed the effectiveness of a specialized geriatric team in the treatment of the elderly. Some studies showed that geriatric teams reduced the incidence of disability and stabilized mortality rates, but other studies have found no effect. However, comprehensive geriatric assessment (CGA) in the home setting appears to be effective in reducing hospitalization rates. Two thirds of people with Alzheimer's disease have a gene for apolipoprotein E4, and several other genes have been implicated in Alzheimer's disease.

Care and treatment, Research, Genetic aspects, Geriatrics

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Geriatric medicine

Article Abstract:

The biggest concern of physicians who specialize in geriatric medicine is preventing disability and the loss of function in the elderly. Many studies have shown that regular exercise can provide many health benefits. A simple walking program can confer significant benefits. People with hypertension who lose weight and avoid high-sodium intakes may be able to stop taking antihypertensive drugs. Bisphosphonates can reduce the risk of bone fracture. Estrogen may reduce the risk of Alzheimer's disease in women but more research is needed. Two drugs have been approved for the treatment of Alzheimer's disease.

Prevention, Dementia, Exercise

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