Siu A L, Kravitz R L, Keeler E, Hemmerling K, Kington R, Davis J W, Mitchell A, Burton T M, Morgenstern H, Beers M H, Reuben D B
Mount Sinai School of Medicine, New York, NY, USA.
Arch Intern Med. 1996 Jan 8;156(1):76-81.
The diffusion of comprehensive geriatric assessment services has been rather limited in North America partly because of reimbursement and organizational constraints.
To evaluate the impact of a comprehensive geriatric assessment intervention for frail older patients that is started before hospital discharge and is continued at home.
Patients older than 65 years were selected who had either unstable medical problems, recent functional limitations, or potentially reversible geriatric clinical problems. Patients (n = 354) were randomly assigned to either the intervention group or a control group. Information on survival, readmissions, nursing home placement, medication use, and health status was collected at 30 and 60 days after hospital discharge.
No differences were observed between the two treatment groups in survival, hospital readmission, or nursing home placement by 60 days. After adjustment for baseline characteristics, no significant differences were observed between the two groups on measures of physical functioning, social functioning, role limitations, health perceptions, pain, mental health, energy and/or fatigue, health change, or overall well-being.
Although efficacy has been demonstrated for some forms of comprehensive geriatric assessment, the types of services that are easier to establish (inpatient consultation services and ambulatory assessment) have not been shown to improve outcomes. Our results indicate that outcomes are unaffected by a limited form of comprehensive geriatric assessment begun in the hospital and completed at home. Further efforts are needed to develop and to evaluate realistic approaches to comprehensive geriatric assessment.
在北美，综合老年评估服务的推广相当有限，部分原因是报销和组织方面的限制。
评估一种针对体弱老年患者的综合老年评估干预措施的影响，该干预措施在出院前开始并在家中持续进行。
选择年龄在65岁以上且患有不稳定医疗问题、近期功能受限或潜在可逆性老年临床问题的患者。患者（n = 354）被随机分配到干预组或对照组。在出院后30天和60天收集有关生存、再入院、养老院安置、药物使用和健康状况的信息。
在60天时，两个治疗组在生存、再次入院或养老院安置方面未观察到差异。在对基线特征进行调整后，两组在身体功能、社会功能、角色限制、健康认知、疼痛、心理健康、精力和/或疲劳、健康变化或总体幸福感等指标上未观察到显著差异。
尽管某些形式的综合老年评估已证明有效，但较易建立的服务类型（住院咨询服务和门诊评估）尚未显示能改善结局。我们的结果表明，在医院开始并在家中完成的有限形式的综合老年评估不会影响结局。需要进一步努力来开发和评估综合老年评估的实际方法。
