Abstract
BackgroundMany older people presenting to Acute Medical Units (AMU) are discharged after only a short stay (< 72 hours), yet many re-present to hospital or die within 1 year. Comprehensive Geriatric Assessment may improve patient outcomes for this group.MethodParticipantsPatients aged > 70 years and scoring positive on a risk screening tool ('Identification of Seniors At Risk') who are discharged within 72 hours of attending an AMU with a medical crisis, recruited prior to discharge. Sample size is 400. Carers of participants will also be recruited.InterventionAssessment on the AMU and further out-patient management by a specialist physician in geriatric medicine. Assessment and further management will follow the principles of Comprehensive Geriatric Assessment, providing advice and support to primary care services.DesignMulti-centre, individual patient randomised controlled trial comparing intervention with usual care.Outcome measurementFollow up is by postal questionnaire 90 days after randomisation, and data will be entered into the study database by a researcher blind to allocation. The primary outcome is the number of days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, health and social care resource use, and scaled outcome measures, including quality of life, disability, mental well-being. Carer strain and well being will also be measured at 90 days.AnalysesComparisons of outcomes and costs, and a cost utility analysis between the intervention and control groups will be carried out.Trial RegistrationISRCTN: ISRCTN21800480
Highlights
Many older people presenting to Acute Medical Units (AMU) are discharged after only a short stay (< 72 hours), yet many re-present to hospital or die within 1 year
Early and rapid hospital triage of patients with medical crises is undertaken in Acute Medical Units (AMUs) in the United Kingdom (UK)
There is a considerable body of evidence supporting the effectiveness of complex interventions for frail older people in general [6], Comprehensive Geriatric Assessment (CGA) [6,7]
Summary
And rapid hospital triage of patients with medical crises is undertaken in Acute Medical Units (AMUs) in the UK. At least 10% of all attendees will be frail older people, identified by the presence of one or more geriatric syndromes [3,4]. Frail older people who present with a crisis to an AMU but. There is a considerable body of evidence supporting the effectiveness of complex interventions for frail older people in general [6], Comprehensive Geriatric Assessment (CGA) [6,7]. We have clinically piloted a version of CGA suitable for use in older people presenting to AMUs, “interface geriatrics”, in which a geriatrician makes a clinical assessment of older patients being discharged from an AMU, and plans any necessary aftercare including further assessment at home and liaison with primary care, intermediate care and specialist community services. This study will evaluate interface geriatrics compared with current management, using a randomised controlled trial with economic analysis
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