A controlled trial of a nursing-centered intervention in hospitalized elderly medical patients: the Yale Geriatric Care Program.

OBJECTIVE

To test the effectiveness of a nursing-centered intervention to prevent functional decline among hospitalized elderly medical patients.

DESIGN

Prospective cohort study with stratified and matched cohort analyses.

SETTING

General medicine wards of a university teaching hospital.

PATIENTS

Two hundred sixteen patients aged > or = 70 years (85 intervention and 131 control patients).

INTERVENTION

The intervention included identification and surveillance of frail older patients, twice-weekly rounds of the Geriatric Care Team, and a nursing-centered educational program.

MAIN OUTCOME MEASURE

Functional decline, defined as a net decline in five activities of daily living (ADLs).

RESULTS

In stratified analyses, the intervention resulted in a beneficial effect with a relative risk of 0.82 (95% confidence interval [CI] 0.54 to 1.24) in patients (n = 106) with one of four geriatric target conditions at baseline (eg, delirium, functional impairment, incontinence, and pressure sores). The intervention had no effect in patients without target conditions at baseline (n = 110); thus, this subgroup was excluded from further analyses. When patients were matched on number of target conditions and risk for functional decline at baseline (n = 66), the intervention resulted in a significant beneficial effect, with a reduction in functional decline from 64% in controls to 41% in the intervention group, for a relative risk of 0.64 (95% CI, 0.43 to 0.96). The intervention group had significantly less decline in ADL score and in individual ADLs than control subjects. Specific interventions aimed at maximizing function, such as physical therapy, were received more often by intervention patients; however, the beneficial effects of the intervention were achieved without increasing per-day hospital costs.

CONCLUSIONS

The intervention appears effective to decrease functional decline in targeted elderly hospitalized medical patients.