ABSTRACT
OBJECTIVES: To measure the effects of outpatient geriatric evaluation and management (GEM) on high-risk older persons' functional ability and use of health services. DESIGN: Randomized clinical trial. SETTING: Ambulatory clinic in a community hospital. PARTICIPANTS: A population-based sample of community-dwelling Medicare beneficiaries age 70 and older who were at high risk for hospital admission in the future (N = 568). INTERVENTION: Comprehensive assessment followed by interdisciplinary primary care. MEASUREMENTS: Functional ability, restricted activity days, bed disability days, depressive symptoms, mortality, Medicare payments, and use of health services. Interviewers were blinded to participants' group status. RESULTS: Intention-to-treat analysis showed that the experimental participants were significantly less likely than the controls to lose functional ability (adjusted odds ratio (aOR) = 0.67, 95% confidence interval (CI) = 0.47-0.99), to experience increased health-related restrictions in their daily activities (aOR = 0.60, 95% CI = 0.37-0.96), to have possible depression (aOR = 0.44, 95% CI = 0.20-0.94), or to use home healthcare services (aOR = 0.60, 95% CI = 0.37-0.92) during the 12 to 18 months after randomization. Mortality, use of most health services, and total Medicare payments did not differ significantly between the two groups. The intervention cost $1,350 per person. CONCLUSION: Targeted outpatient GEM slows functional decline.
Subject(s)
Geriatric Assessment , Aged , Female , Humans , Male , Outcome and Process Assessment, Health Care , Outpatients , Patient Care TeamABSTRACT
OBJECTIVE: To measure the validity of the DETERMINE Checklist as a marker for future functional disability, depressive symptoms, and mortality among high-risk older adults. DESIGN: A Cohort study. SETTING: An Urban-suburban Midwestern community. PARTICIPANTS: Community-dwelling Medicare beneficiaries at high risk for hospital admission who received geriatric evaluation and management (GEM) (n = 251). MEASUREMENTS: Demographic, health-related, functional, psychosocial, survival, and nutritional data were collected through telephone and in-home interviews. RESULTS: GEM recipients with baseline Checklist scores of four or higher were found to be significantly more likely than those with lower scores to have functional disability or high levels of depressive symptoms a year later. Checklist scores did not predict mortality. CONCLUSIONS: The 10-item Checklist could be used as a secondary screen to identify older persons who, without treatment, are at especially high-risk to have disability or depression a year later.
