Geriatric inpatient units in the care of hospitalized frail adults with a history of heart failure


Journal Article

Background: Frail hospitalized older adults are at risk for adverse outcomes. Previous studies have suggested benefits for inpatient geriatric management (GEM). We sought to determine whether hospitalized patients with a history of heart failure (HF) benefitted from inpatient GEM or not. Methods: We studied 309 inpatients previously diagnosed with HF who were participants in a randomized trial of geriatric evaluation and management (GEM) versus usual care (UC). The intervention involved multidisciplinary teams that provided comprehensive geriatric assessment. We evaluated health-related quality of life (HRQOL), basic activities of daily living (ADLs), health service utilization, and survival at discharge, 6 months, and 1 year post randomization. Results: GEM patients had higher mean change scores for physical function (unadjusted means: 0.17 vs. -4.67, p = 0.046) and basic ADLs (1.25 vs. 0.67, p = 0.003) at hospital discharge, which remained significant after adjusting for baseline HRQOL scores and in-hospital days. Outcomes were not significantly different at 1 year. Length of stay for GEM was greater than UC (24 days vs. 17 days, p = 0.03), but total costs at 1 year were not different (p = 0.9). Mortality rates at 1 year were high and similar (GEM 29.0%, UC 27.3%, p = 0.73) in both the groups. Conclusion: Inpatient GEM was associated with better maintenance of physical function and basic ADLs at hospital discharge; however, no differences in HRQOL or survival were observed between GEM and UC at 1 year post randomization. Restructuring inpatient care models to incorporate inpatient GEM principles may be one method to optimize health-care delivery. © 2012, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.

Full Text

Duke Authors

Cited Authors

  • Gharacholou, SM; Sloane, R; Cohen, HJ; Schmader, KE

Published Date

  • January 1, 2012

Published In

Volume / Issue

  • 6 / 2

Start / End Page

  • -116 -

Electronic International Standard Serial Number (EISSN)

  • 1873-958X

International Standard Serial Number (ISSN)

  • 1873-9598

Digital Object Identifier (DOI)

  • 10.1016/j.ijge.2012.01.012

Citation Source

  • Scopus