Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “GERIATRICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources
PubMed2000

[The community activity of a hospital geriatrics service: a practical example of coordination between primary and specialized care].

OBJECTIVES: To describe the management of the geriatric hospital home assessment team to support at primary care in the need of health of geriatric patients. DESIGN: Prospective observational study. SETTING: 5-North health district from Madrid. PARTICIPANTS AND METHODS: All patients evaluated at home and the coordination activities between primary care and hospital geriatric service, developed by the geriatric assessment team between january 1997 at december 1999. Inquiry to primary care physicians about the usefulness of geriatric hospital home assessment team. MAIN RESULTS: 524 patients was assisted at home by the geriatric assessment team to request primary care (58.4% at all patients attended), 83.24 +/- 7.21 years old (68.1% females), with pluripathology (4.02 +/- 1.86 diagnostics) and polypharmacy (4.95 +/- 2.8), moderate-severe functional disability (Barthel Index < 60 at 65% and Red Cross functional disability > 2 at 74.4%) and frequently cognitive impairment (41.2% with Pfeiffer > 5). The main reasons of primary care to consult was functional impairment (28.4%), medical process assessment (16.2%), geriatric assessment (13.2%), skin ulcers (13.2%) and behavioral disorders (10.8%). 865 telephone call and 178 meeting in health center of primary care for consultation or medical management or for coordinating medical management was attended. 62% of primary care physician inquired to answer back. The belief of 100% answers was about de usefulness of the geriatric assessment team activity, mainly because their specialization on geriatric care (76.7%) and their responsibility of the hospital resources (65.1%). CONCLUSIONS: The activity of geriatric hospital home assessment team is useful as support of primary care on assessment and management geriatric patients in the community and coordinate hospital and primary care to resolve health problems in this population.

Aged↗
PubMedDate not supplied

Hospital utilization and readmission rates for geriatric and young adult patients with major depression: results from a historical cohort study.

Late-life depression may have different clinical features, hospital utilization patterns, and natural history, depending on whether the illness begins in midlife or late life. This historical cohort study examined three patient groups, late-onset geriatric depressed patients, early-onset geriatric depressed patients, and young adult depressed patients, to determine hospital utilization patterns, readmission rates, and whether specific clinical symptoms on admission predisposed patients to readmission. The two geriatric patient groups had similar demographic, medical comorbidity, and hospital utilization profiles, except that the early-onset geriatric depressed group had longer hospital lengths of stay. Hospital utilization patterns for the young adult patients were different from the geriatric patients, but in the expected direction, ie, less medical comorbidity and shorter lengths of stay. Patients with late-onset geriatric depression had the highest 24-month readmission rate (47.4%), followed by early-onset geriatric depression patients (23.1%) and young adult patients (16.7%). Delusional symptoms and agitation were similar across the three patient groups and, as expected, somatic complaints were more frequent in the geriatric patient groups. The relative risk for readmission was greatest for geriatric patients who were somatic. Readmission risk was increased for agitated late-onset geriatric depressed patients and young adult patients, but not for early-onset geriatric depressed patients. Delusional symptoms did not predict readmission for any patient group.

Adult↗
PubMed2002

A controlled trial of inpatient and outpatient geriatric evaluation and management.

BACKGROUND: Over the past 20 years, both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management. However, the effects of these interventions on survival and functional status remain uncertain. METHODS: We conducted a randomized trial involving frail patients 65 years of age or older who were hospitalized at 11 Veterans Affairs medical centers. After their condition had been stabilized, patients were randomly assigned, according to a two-by-two factorial design, to receive either care in an inpatient geriatric unit or usual inpatient care, followed by either care at an outpatient geriatric clinic or usual outpatient care. The interventions involved teams that provided geriatric assessment and management according to Veterans Affairs standards and published guidelines. The primary outcomes were survival and health-related quality of life, measured with the use of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), one year after randomization. Secondary outcomes were the ability to perform activities of daily living, physical performance, utilization of health services, and costs. RESULTS: A total of 1388 patients were enrolled and followed. Neither the inpatient nor the outpatient intervention had a significant effect on mortality (21 percent at one year overall), nor were there any synergistic effects between the two interventions. At discharge, patients assigned to the inpatient geriatric units had significantly greater improvements in the scores for four of the eight SF-36 subscales, activities of daily living, and physical performance than did those assigned to usual inpatient care. At one year, patients assigned to the outpatient geriatric clinics had better scores on the SF-36 mental health subscale, even after adjustment for the score at discharge, than those assigned to usual outpatient care. Total costs at one year were similar for the intervention and usual-care groups. CONCLUSIONS: In this controlled trial, care provided in inpatient geriatric units and outpatient geriatric clinics had no significant effects on survival. There were significant reductions in functional decline with inpatient geriatric evaluation and management and improvements in mental health with outpatient geriatric evaluation and management, with no increase in costs.

Activities of Daily Living↗
PubMed1992

Geriatric care approaches in health maintenance organizations.

The objective of this project was to describe geriatric care provided under Medicare-risk contracts in HMOs with established Medicare programs. These findings provided the basis for an invitational workshop, sponsored by the National Institute on Aging and the Robert Wood Johnson Foundation, to formulate a research agenda for geriatric care in HMOs. The case study method involved site visits to seven HMOs by a physician with expertise in geriatrics, a managed care specialist, and a program development specialist. Representatives from the HMOs included senior executive officials, physicians recognized for providing and promoting geriatric care, research and program development staff, and various clinical staff including pharmacists, geriatric nurse practitioners, nurses, and social workers. The most frequently encountered geriatric care programs were categorized by the following six objectives: (1) identifying high risk patients, (2) assessing multi-problem patients, (3) treating multi-problem patients, (4) rehabilitating patients following acute events, (5) reducing medication problems, and (6) providing long-term care and home health care. Unique programs identified from these site visits included screening methods for new enrollees, approaches to comprehensive geriatric assessment, use of skilled nursing facilities for intensive rehabilitation and postacute care, and drug profiling and review. Utilization of geriatric nurse specialists and programs aimed at coordination with social services were pervasive in many of these HMOs. Workshop participants proposed several research and demonstration projects in all six areas. Overall consensus emerged that HMOs with Medicare-risk contracts provide a valuable setting for experimentation in geriatric care. Given the current health policy emphasis on managed care and capitated payment methodologies, geriatric care research in HMOs should be a high priority.

Geriatric Assessment↗
PubMed2001

[Geriatric wards in a psychiatric and a general hospital: a comparison of problems leading to admission of the patient].

The aim of this investigation was the comparison and description of actual problems of patients admitted to a geriatric ward of a mental hospital and patients admitted to the geriatric ward of a general hospital. The study was conducted in the geriatric unit of the Vincent van Gogh Institute of Psychiatry, in Venray and the geriatric unit in St. Maartens Gasthuis in Venio, both in the Netherlands. The design was retrospective. Data were obtained from discharge letters. The relevant diagnoses and the aetiology of the problems of all patients admitted in 1994 were categorized and compared by means of classification systems and models (medical, synergistic and causal chain model). Approximately 80 percent of the patients admitted to the geriatric unit of the mental hospital turned out to have a physical diagnosis relevant to the problems and almost every patient had a relevant psychiatric diagnosis. Life events and relationship problems played an important part. More than half of the patients admitted to the geriatric unit of the general hospital had a relevant psychiatric diagnosis and almost every patient had a physical diagnosis relevant to the problems. Mostly the aetiology of the problems of the patients of the geriatric unit of the mental hospital can be described by means of the medical model. The aetiology of the problems of the patients of the geriatric unit of the general hospital can mainly be described by the synergistic model. The causal chain model is seldom found. An event is more frequently found in the geriatric unit of the mental hospital. Often the referring Doctor could not point out adequately the underlying cause of the problems. We conclude that the problems of the patients, admitted to the geriatric unit of a mental and of a general hospital, differ substantially and in both units the problems are complex, in terms of diagnoses, aetiology and/or treatment.

Aged↗
PubMed2001

[Geriatric care in Germany--results of an empirical study].

BACKGROUND: In Germany, the situation of geriatric medicine has improved significantly over the past few years. Until now, though, there was little information available on the structure of the clinical geriatric departments. Since this information is vital to assess whether these departments can provide high-quality services, the German Federal Association of Clinical Geriatric Departments conducted a survey among its members. The goal was to gain deeper insight into the structure of the geriatric acute hospitals and rehabilitation units. METHODS: In 1999, member institutions were mailed a standardized questionnaire and all institutions (100%) returned the questionnaire to the association's central office. To increase data quality, data were screened and reports were generated for each institution. These reports were returned to the institutions which were asked to verify them. RESULTS: This article shows that in 1998 acute geriatric hospitals (n = 89), rehabilitation units (n = 52), acute day clinics (n = 45) and rehabilitation day clinics (n = 26) had--on average--60/60/15.3/14 beds/places and 828.15/677.3/164.2/125.9 patients. Occupancy rates averaged out at 88.7%/84.3%/86.4%/63.7% and daily hospital rates at DM 401.4/322.4/293.8/243.2. Basically, all geriatric institutions included in this survey had a multi-professional geriatric team. Patient-to-staff ratios for psychologists, social workers, ergo-, physio- and speech therapists were better in day clinics than in in-patient clinics and better in rehabilitation units than in acute hospitals. Geriatric institutions mainly focused on the treatment of neurological deficits. Most patients were admitted from other hospitals and discharged to their private residence. CONCLUSIONS: The results of this survey indicate that especially the acute hospitals are often not sufficiently staffed. Moreover, further efforts are necessary to clarify the indications for and modalities of geriatric day clinic treatment and rehabilitation. The data also show that a categorical distinction between geriatric acute hospitals and rehabilitation units is not possible. However, further data collection and more detailed analyses are needed.

Aged↗
PubMed2003

Economic evaluation of a geriatric day hospital: cost-benefit analysis based on functional autonomy changes.

OBJECTIVE: to investigate whether the benefits related to a geriatric day hospital programme exceeded the costs, using a cost-benefit analysis based on changes in functional autonomy. DESIGN: a quasi-experimental design with a historical cohort as comparison group. SETTING: the geriatric day hospital programme at the Sherbrooke Geriatric University Institute in the Province of Quebec, Canada. SUBJECTS: 151 geriatric day hospital patients. METHODS: after admission to and at discharge from the geriatric day hospital programme, functional autonomy was assessed by a trained nurse using the Functional Autonomy Measurement System. Based on financial reports, costs associated with resources consumed at the geriatric day hospital programme by each subject were established. The benefit in dollars per day was estimated with a societal perspective through regression equations based on functional autonomy changes related to the geriatric day hospital programme. A model for spreading the benefit per day was proposed: the median time to institutionalisation or death. RESULTS: for every dollar invested in the geriatric day hospital programme, the benefit for the health system was $2.14 (95% confidence interval: $1.72-$2.56). CONCLUSION: based on our sample of Sherbrooke Geriatric University Institute patients, the benefit related to the geriatric day hospital programme seems to exceed the costs.

Activities of Daily Living↗
PubMed2003

[Medical students' understanding of geriatric medicine].

With the rapid aging of Japan's population, medical professionals who specialize in geriatric medicine are in unprecedented demand. At Ehime University School of Medicine, the Department of Geriatric Medicine was established on April 1,1997. To assess the status of geriatric medicine in undergraduate education, we surveyed the opinions of medical students on geriatric medicine. A questionnaire was sent to both fourth-year medical students before their classes on internal medicine and geriatric medicine had ended and to sixth-year medical students after their classes had already ended. Medical students of Ehime University School of Medicine had significantly more interest in geriatric medicine than students at other medical schools. From a clinical viewpoint of problems in old age, they considered that cerebrovascular disease, cardiovascular disorders, neurocognitive disorders and pulmonary disease were important. A total of 60% agreed that all medical schools should have classes in geriatric medicine, which is a higher rate than that of previous reports. To study the opinions of medical students on textbooks on geriatrics, we also conducted a questionnaire among medical students. Although 90% of students had their own textbooks of internal medicine and almost half (42%) had textbooks on physical examination, none had their own textbook of geriatric medicine. The most frequent reason was "hard to choose the best textbook". The present study indicates that to develop education in geriatric medicine, it is important to make a recommendable text book for medical students, which is easily understood with high quality and originality.

Attitude to Health↗
PubMed2003

Improving geriatrics training in internal medicine residency programs: best practices and sustainable solutions.

National surveys indicate a need for additional training in geriatrics during internal medicine residencies. This paper describes 1) "best practices" for integrating geriatrics education into internal medicine residency programs, 2) barriers to implementation of these practices, and 3) possible ways to improve geriatrics training for internal medicine residents. These best practices were determined by a systematic review of the literature and through interviews with leaders of 26 residency and geriatrics programs concerned with geriatrics training for residents. The most successful programs have clinical experiences with 3 key elements: model geriatric care in 1 or more settings (for example, in the hospital or in ambulatory practice), patient care across sites or transitions of care, and interdisciplinary teamwork. Barriers include attitudes, few faculty, need for relationships with nontraditional training sites, and lack of funding. Local solutions include engaging the internal medicine program director to accomplish a mutual goal--for example, by creating a model geriatrics training experience in which residents demonstrate their skill in a new Accreditation Council of Graduate Medical Education competency (such as systems-based practice). National solutions include reaching consensus on the competencies in geriatrics that should be achieved by board-eligible internists. This may mean increasing the number of questions that test geriatrics competency in the certifying and in-training examinations, increasing numbers of faculty members able to teach and model geriatric care, developing "effective medical resident teaching" courses for nonphysician faculty, and lobbying for improved systems of care.

Curriculum↗
PubMedDate not supplied

Are some subjects better taught in block rotation? A geriatric experience.

BACKGROUND AND OBJECTIVES: This study characterizes the progress in and effectiveness of learning geriatric medicine during longitudinal and block phases of a family practice residency program. METHODS: A structured second-year geriatric block rotation was added to a residency longitudinal curriculum. To assess learning, a Geriatric Assessment Instrument (GAI) consisting of 50 multiple choice questions was administered to three classes offamily practice residents (n=33)five times during training: entry into the program, beginning of the second year, pre- andpost-geriatric block rotation, and at graduation. Improvement between individual residentfirst- and third-year in-training exam scores in geriatrics of the intervention classes were compared with the four classes that preceded the introduction of the block rotation (n=38). RESULTS: Scores on the GAI improved significantly before and after the rotation but not during any other interval of training during the residency. In-training exam scores improved significantlyfor the classes taught with the block rotation over those without it. CONCLUSIONS: Most of the geriatric learning occurred during the 1-month geriatric block rotation during the residency. In-training geriatric exam scores improved significantly with a geriatric block rotation. The use of structured repetitive learning experiences during the rotation to emphasize the common clinical issues and the skewed exposure to geriatric patients in the random nature of residency clinic and inpatient encounters accountfor this result.

Aged↗
PubMed2003

Geriatrics in family practice residency education: an unmet challenge.

The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

Aged↗
PubMed1991

Interest in geriatrics education among family practitioners and internists in Virginia.

To determine primary care physicians' interest in continuing medical education (CME) in geriatrics, the authors surveyed all Virginia family practice (FP) physicians and internal medicine (IM) physicians, a total of 1,882. Sixty-one percent (1,139) responded, of which 56% were FP physicians and 44% were in IM. On a visual analog scale to measure the physicians' interest in geriatrics education (from 1 = unimportant to 10 = very important), the FP physicians' mean score was 6.4; the IM physicians' mean score was 6.1. The preferred form of education was a two-to-three-day conference, and the preferred topics were acute care, long-term care, and rehabilitation. Stepwise multiple regression showed that the physicians' intent to take the Added Qualifications in Geriatric Medicine examination was the major predictor of their interest in geriatrics education (R2 = .12, p = .0001). Also significant contributors were the total amount of geriatric care the physicians provided, the home visits they provided, their prior participation in geriatrics CME conferences, absence of a negative attitude toward the Medicare system, and their lack of confidence in their current knowledge of geriatrics. The final model could account for 20% of these physicians' interest in future CME in geriatrics (R2 = .20). These findings may help geriatrics educators develop methods to educate primary care providers about geriatrics.

Education, Medical, Continuing↗
PubMed1993

Geriatric education and practice of family practice graduates: an alumni survey.

BACKGROUND: The goal of this research was to study the relationship between family practice residency training in geriatrics and subsequent postresidency geriatric practice patterns. METHODS: We surveyed all graduates of the University of Maryland Family Practice Residency Program through 1990 to determine their attitudes toward their geriatric training and the extent of their geriatric practice. Logistic regression analysis was used to identify factors associated with 1) making house calls, 2) making weekly nursing home visits, and 3) having a practice in which more than 25% of patients were older than age 65. RESULTS: The responses of 143 graduates were analyzed. Most respondents (58.8%) made house calls, and the majority (51%) saw nursing home patients weekly. Older respondents and those possessing Certificates of Added Qualifications in Geriatric Medicine (CAQGMs) were more likely to treat patients older than age 65. Respondents with larger nursing home practices rated their geriatric training more favorably. Multivariate logistic regression analysis found that the following factors were associated with making house calls: working in a group family practice (odds ratio [OR] = 3.88, 95% confidence interval [CI] = 2.58-5.84) and a rural practice location (OR = 2.71, 95% CI = 1.77-4.17). Physicians who had additional training after residency (OR = 0.16, 95% CI = 0.10-0.25) were less likely to make house calls. Factors associated with making weekly nursing home visits were: additional training after residency (OR = 0.31, 95% CI = 0.19-0.50) and working in a group family practice (OR = 2.43, 95% CI = 1.63-3.65). Attainment of a CAQGM was the only factor associated with having more than 25% geriatric patients in the office practice (OR = 6.00, 95% CI = 2.72-13.24). CONCLUSIONS: Most graduates of the University of Maryland Family Practice Residency Program maintain significant geriatric practices and value geriatric training, but whether favorable training experiences influence graduates' practices is unknown. Prospective studies of family practice residents are needed to clarify the influence of geriatric curricula on residents' future clinical practices.

Family Practice↗
PubMedDate not supplied

Comparison of characteristics between geriatric and younger subjects with schizophrenia in community.

Relatively little is known about the different characteristics of non-institutionalized geriatric and younger subjects with schizophrenia. This study compared demographic and clinical characteristics of all the geriatric, middle-age and young subjects with schizophrenia living in a Chinese rural community. Geriatric (age >/= 65 years) (N = 51), middle-age (age 41-64 years) (N = 263) and young subjects with schizophrenia (age 15-40 years) (N = 196) in a rural community were assessed with the Present State Examination and Social Disability Screening Schedule. Age at first onset was significantly older in geriatric male and female groups. While there were no significant differences of negative symptoms among the three groups, the rates of lifetime nuclear syndrome were significantly lower in geriatric subjects compared to the other two groups. Geriatric subjects were less likely to have been hospitalized (9.8%) than middle-age (19.0%) and younger subjects (24.8%). Although the duration of illness was significantly longer in geriatric subjects than in the other two groups, the clinical outcome was significantly better in the geriatric group and social functioning scores were similar among the three groups. Geriatric subjects were more likely to be female, with longer duration of illness, fewer "core" symptoms, relatively stable social functioning and clinical outcome. The pathogenesis and psychopathology of geriatric subjects may be different compared to younger subjects with schizophrenia.

Adolescent↗
PubMed1997

Geriatric urolithiasis.

PURPOSE: We define the differences between geriatric patients with urinary stone disease compared to a younger cohort. MATERIALS AND METHODS: A data base, including serum biochemical profiles, 24-hour urinalyses and standardized questionnaires, was retrospectively evaluated from more than 6,000 consecutive patients with urinary stone disease. RESULTS: Geriatric stone formers comprised 12% (721) of all stone patients. Two-thirds of these elderly patients had aberrant urinary values and 29% had isolated hypocitraturia compared to 17% in the younger group. Of geriatric stone forming patients 76% had recurrent urinary stones (mean 3.5 stone episodes), which was similar to the younger comparable group (77%, mean 3.3 stone episodes). The severity of urinary stone disease was similar between the 2 groups based on the need for urological intervention. Geriatric stone patients, in general, experienced the first stone episode later in life (after age 50 years) compared with younger patients. Elderly patients had an increased incidence of uric acid stones, but had a similar incidence of struvite calculi. Geriatric stone patients underwent parathyroid surgery more frequently (2.7 versus 0.7%). Geriatric stone forming patients rarely had renal failure. CONCLUSIONS: The incidence, recurrence and severity of recurrent urinary stone disease were similar between geriatric and younger stone forming patients. Geriatric stone patients had an increased incidence of isolated hypocitraturia, uric acid calculi and previous parathyroidectomy. The geriatric stone population is not merely an extension of younger stone forming patients presenting at an older age. Rather, geriatric patients commonly experience the first symptomatic stone episode later in life.

Age Distribution↗
PubMed2002

Academic geriatric programs in US allopathic and osteopathic medical schools.

CONTEXT: By 2030, 20% of the US population will be older than 65 years compared with 12.4% in 2000. The development of geriatric medicine research and training programs to prepare for this increasing number of older individuals is largely dependent on the successful establishment of academic geriatric medicine programs in medical schools. OBJECTIVE: To assess the structure, resources, and activities of academic geriatric medicine programs in US allopathic and osteopathic schools of medicine. DESIGN, SETTING, AND PARTICIPANTS: Survey distributed to the academic geriatric medicine leaders of the 144 US allopathic and osteopathic medical schools in March 2001. MAIN OUTCOME MEASURES: Organizational structure, program information, curriculum, budgetary issues, and characteristics of academic geriatric medicine leaders. RESULTS: A total of 121 program directors (84%) responded. Most schools (87%) had an identifiable academic geriatric program structure, with 67% established after 1984. The greatest proportion of faculty and staff time (40%) was spent in clinical practice, followed by research and scholarship (12%), residency and fellowship education (10% each), and medical student education (7.8%). Clinical practice accounted for the greatest portion (27%) of revenue, and 25.7% of the programs had total annual budgets of less than $250,000, while 11% had budgets of greater than $5 million. The largest obstacles to achieving the goals of an academic geriatric medicine program were a lack of research faculty and fellows and poor clinical reimbursement. CONCLUSIONS: Most US medical schools have an identifiable academic geriatric medicine program; most have been established within the last 15 years. Resources are needed to train faculty for roles as teachers and researchers and to develop medical school geriatric programs of the size and scope equivalent to other academic disciplines.

Data Collection↗
PubMed1994

Outcomes in treatment of pain in geriatric and younger age groups.

Chronic pain treatment outcome studies have generated conflicting information on whether geriatric (age 65+) patients (1) benefit from pain center treatment, and (2) benefit as much as do other age groups. We asked chronic pain patients to rate themselves at pain center admission and discharge on 43 scales assessing area of pain, functional status, behavioral variables, and other areas (pain center modification goals). Patients were placed into one of three age groups: "geriatric" (n = 153); "middle aged" 45 to 64 years (n = 126); and "younger" 21 to 44 years (n = 191). First, tests of geriatric improvement were performed. Next, the three groups were compared on baseline variables and on overall admission, discharge, and change scores. Change scores of the three groups were compared using analysis of covariance, followed by pairwise post hoc tests. Overall, the geriatric group improved on 42 of the 43 scales (p < .001). Geriatric improvement was significant on 37 scales, with most scales being significant at p < .001. Geriatric patients were significantly different from the other two groups on most baseline variables. Their admission scores were better than the other two groups. Geriatric improvement was not significantly different from the other two groups on 37 of the scales. Geriatric change was significantly better on two scales and significantly worse on 4 scales. Geriatric chronic pain patients are (1) distinctly different from younger chronic pain patients, (2) show significant and meaningful improvement with pain center treatment, and (3) demonstrate as great an improvement as the other age groups in the majority of measures.

Activities of Daily Living↗
PubMed2004

Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly.

PURPOSE: To determine if inpatient or outpatient geriatric evaluation and management, as compared with usual care, reduces adverse drug reactions and suboptimal prescribing in frail elderly patients. METHODS: The study employed a randomized 2 x 2 factorial controlled design. Subjects were patients in 11 Veterans Affairs (VA) hospitals who were > or =65 years old and met criteria for frailty (n = 834). Inpatient geriatric unit and outpatient geriatric clinic teams evaluated and managed patients according to published guidelines and VA standards. Patients were followed for 12 months. Blinded physician-pharmacist pairs rated adverse drug reactions for causality (using Naranjo's algorithm) and seriousness. Suboptimal prescribing measures included unnecessary and inappropriate drug use (Medication Appropriateness Index), inappropriate drug use (Beers criteria), and underuse. RESULTS: For serious adverse drug reactions, there were no inpatient geriatric unit effects during the inpatient or outpatient follow-up periods. Outpatient geriatric clinic care resulted in a 35% reduction in the risk of a serious adverse drug reaction compared with usual care (adjusted relative risk = 0.65; 95% confidence interval: 0.45 to 0.93). Inpatient geriatric unit care reduced unnecessary and inappropriate drug use and underuse significantly during the inpatient period (P <0.05). Outpatient geriatric clinic care reduced the number of conditions with omitted drugs significantly during the outpatient period (P <0.05). CONCLUSION: Compared with usual care, outpatient geriatric evaluation and management reduces serious adverse drug reactions, and inpatient and outpatient geriatric evaluation and management reduces suboptimal prescribing, in frail elderly patients.

Aged↗