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Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU NAL Uddevalla Hospital Grp, Sweden.
University of Gothenburg, Sweden.
University of Gothenburg, Sweden.
NU Hospital Grp, Sweden.
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2017 (English)In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, p. 1239-1248Article in journal (Refereed) Published
Abstract [en]

Background: A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services. Results: After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052-0.164; P amp;lt; 0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131-0.400; P amp;lt; 0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085-0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395-1.178; P=0.170). Conclusion: Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD , 2017. Vol. 12, p. 1239-1248
Keywords [en]
frail elderly; comprehensive geriatric assessment; acute care; functional outcomes
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:liu:diva-140080DOI: 10.2147/CIA.S139230ISI: 000407121800004OAI: oai:DiVA.org:liu-140080DiVA, id: diva2:1136571
Note

Funding Agencies|Healthcare sub-committee, Region Vastra Gotaland; Department of Research and Development, NU Hospital Group; Fyrbodal Research and Development Council, Region Vastra Gotaland, Sweden

Available from: 2017-08-28 Created: 2017-08-28 Last updated: 2017-09-13

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Ekerstad, NiklasHusberg, MagnusAlwin, Jenny
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