老年住院体弱患者的老年评估与管理咨询服务随机试验。

A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients.

作者信息

Kircher Tilo T J, Wormstall Henning, Müller Peter H, Schwärzler Frank, Buchkremer Gerhard, Wild Klaus, Hahn Johannes-Martin, Meisner Christoph

机构信息

Department of Psychiatry, University of Tübingen, Osianderstr. 24, D-72076 Tübingen, Germany.

出版信息

Age Ageing. 2007 Jan;36(1):36-42. doi: 10.1093/ageing/afl102.

DOI:10.1093/ageing/afl102

PMID:17264136

Abstract

BACKGROUND

the usefulness of geriatric evaluation and management (GEM) approaches in the care of frail elderly patients remains uncertain. We examined whether an inpatient geriatric consultation service might be beneficial in a country with a social welfare system.

METHODS

we conducted a randomised trial with 345 patients from five centres. Ninety additional patients from four separate centres without GEM teams served as an external comparison. All patients were hospitalised, at least 65 years and frail. Patients were randomly assigned to either comprehensive geriatric assessment and management in the form of consultations and follow-up or usual care. Primary outcomes were rehospitalisation and nursing home placement 1 year after randomisation. Secondary outcomes were survival, functional, emotional and cognitive status, social situation and quality of life.

FINDINGS

at 12 months, the groups did not differ in the rate of rehospitalisation (intervention 67%, control 60%, P=0.30), nursing home placement (intervention 19%, control 14%, P=0.27), survival (intervention 81%, control 85%, P=0.56) or any of the other secondary measures. The external comparison groups were also similar in nursing home placement (16%, P=0.40), survival (80%, P=0.88) and all the secondary variables, but rehospitalisation was less (48%, P=0.04). No subgroup benefited from the intervention.

INTERPRETATION

care provided by consultation teams did not improve the rates of rehospitalisation or nursing home placement. This is not due to carry-over effects of geriatric knowledge into the control group.

摘要

背景

老年评估与管理（GEM）方法在体弱老年患者护理中的作用仍不确定。我们研究了在一个拥有社会福利体系的国家，住院老年会诊服务是否有益。

方法

我们对来自五个中心的345名患者进行了一项随机试验。来自四个没有GEM团队的独立中心的另外90名患者作为外部对照。所有患者均住院，年龄至少65岁且体弱。患者被随机分配接受以会诊和随访形式的综合老年评估与管理或常规护理。主要结局是随机分组后1年的再住院率和养老院安置情况。次要结局是生存率、功能、情绪和认知状态、社会状况及生活质量。

研究结果

在12个月时，两组在再住院率（干预组67%，对照组60%，P = 0.30）、养老院安置情况（干预组19%，对照组14%，P = 0.27）、生存率（干预组81%，对照组85%，P = 0.56）或任何其他次要指标方面均无差异。外部对照组在养老院安置情况（16%，P = 0.40）、生存率（80%，P = 0.88）及所有次要变量方面也相似，但再住院率较低（48%，P = 0.04）。没有亚组从干预中获益。