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Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. NU NAL Uddevalla Hospital Grp, Sweden.
University of Gothenburg, Sweden.
University of Gothenburg, Sweden.
University of Gothenburg, Sweden.
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2017 (Engelska)Ingår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged amp;gt;= 75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.14-0.79), ambulation (OR =0.19, 95% CI = 0.1-0.37), dexterity (OR =0.38, 95% CI =0.19-0.75), emotion (OR =0.43, 95% CI =0.22-0.84), cognition (OR =0.076, 95% CI =0.033-0.18) and pain (OR =0.28, 95% CI =0.15-0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] = 0.55, 95% CI = 0.32-0.96), and the two groups did not differ significantly in terms of hospital care costs (Pamp;gt;0.05). Conclusion: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost.

Ort, förlag, år, upplaga, sidor
DOVE MEDICAL PRESS LTD , 2017. Vol. 12
Nyckelord [en]
frailty; elderly; acute care; intervention; comprehensive geriatric assessment
Nationell ämneskategori
Geriatrik
Identifikatorer
URN: urn:nbn:se:liu:diva-133878DOI: 10.2147/CIA.S124003ISI: 000390471100001PubMedID: 28031704OAI: oai:DiVA.org:liu-133878DiVA, id: diva2:1065126
Anmärkning

Funding Agencies|Health Care Subcommittee, Region Vastra Gotaland; Department of Research and Development, NU Hospital Group; Fyrbodal Research and Development Council, Region Vastra Gotaland, Sweden

Tillgänglig från: 2017-01-13 Skapad: 2017-01-13 Senast uppdaterad: 2020-02-27

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