A randomized trial of comprehensive geriatric assessment and home intervention in the care of hospitalized patients

Objective: to prove the effectiveness of geriatric evaluation and management for elderly, hospitalized patients, combined with post-discharge home intervention by an interdisciplinary team. Design: randomized controlled trial with outcome and costs assessed for 12 months after the date of admission. Setting: university-affiliated geriatric hospital and the homes of elderly patients. Subjects: 545 patients with acute illnesses admitted from home to the geriatric hospital. Interventions: patients were randomly assigned to receive either comprehensive geriatric assessment and postdischarge home intervention (intervention), comprehensive geriatric assessment alone (assessment) or usual care (control). Main outcome measures: survival, functional status, rehospitalization, nursing home placement and direct costs over 12 months. Results: the intervention group showed a significant reduction in length of hospital stay (33.49 days vs 40.7 days in the assessment group and 42.7 days in the control group; P < 0.05) and rate of immediate nursing home placement (4.4% vs 7.3% and 8.1%; P < 0.05). There was no difference in survival, acute care hospital readmissions or new admissions to nursing homes but the intervention group had significantly shorter hospital readmissions (22.2 days vs 34.2 days and 35.7 days; P < 0.05) and nursing home placements (114.7 days vs 161.6 days and 170.0 days; P < 0.05). Direct costs were lower in the intervention group [about DM 7000 (US $4000) per person per year]. Functional capacities were significantly better in the intervention group. Conclusions: comprehensive geriatric assessment in combination with post-discharge home intervention does not improve survival, but does improve functional status and can reduce the length of the initial hospital stay and of subsequent readmissions. It can reduce the rate of immediate nursing home admissions and delay permanent nursing home placement. It may also substantially reduce direct costs of hospitalized patients.