Short-term geriatric assessment units: 30 years later

Judith Latour,Paule Lebel,Aline Bolduc,Nicole Leduc,Katherine Berg,Marie-Jeanne Kergoat,Bernard-Simon Leclerc

doi:10.1186/1471-2318-10-41

Abstract

BackgroundThe increasing number of hospitalized elderly persons has greatly challenged decision makers to reorganize services so as to meet the needs of this clientele. Established progressively over the last 30 years, the short-term Geriatric Assessment Unit (GAU) is a specialized care program, now implemented in all the general hospital centres in Quebec. Within the scope of a broader reflection upon the appropriate care delivery for elderly patients in our demographic context, there is a need to revisit the role of GAU within the hospital and the continuum of care. The objective of this project is to describe the range of activities offered by Quebec GAU and the resources available to them.MethodsIn 2004, 64 managers of 71 GAU answered a mail questionnaire which included 119 items covering their unit's operation and resources in 2002-2003. The clinical and administrative characteristics of the clientele admitted during this period were obtained from the provincial database Med-Echo. The results were presented according to the geographical location of GAU, their size, their university academic affiliation, the composition of their medical staff, and their clinical care profile.ResultsOverall, GAU programs admitted 9% of all patients aged 65 years and older in the surveyed year. GAU patients presented one or more geriatric syndromes, including dementia. Based on their clientele, three distinct clinical care profiles of GAU were identified. Only 19% of GAU were focused on geriatric assessment and acute care management; 23% mainly offered rehabilitation care, and the others offered a mix of both types. Thus, there was a significant heterogeneity in GAU's operation.ConclusionsThe GAU is at the cutting edge of geriatric services in hospital centres. Given the scarcity of these resources, it would be appropriate to better target the clientele that may benefit from them. Standardizing and promoting GAU's primary role in acute care must be reinforced. In order to meet the needs of the frail elderly not admitted in GAU, alternative care models centered on prevention of functional decline must be applied throughout all hospital wards.

Highlights

The increasing number of hospitalized elderly persons has greatly challenged decision makers to reorganize services so as to meet the needs of this clientele
In a Geriatric Evaluation and Management Unit (GEMU) [3,7,11,14,15,16] the patient is most often transferred from other wards for the sub-acute phase of her/his illness and admitted under the responsibility of the geriatric team, whereas, in the
In the Acute Care of Elders Unit [5,17,18], the physical surroundings are adapted, a preventive and interdisciplinary approach is applied, without, the geriatric team being the sole treatment team. These units characteristically admit a frail population with at least one inability to perform the activities of daily living (ADL), but that must present the potential to benefit from the intervention

Summary

Introduction

The increasing number of hospitalized elderly persons has greatly challenged decision makers to reorganize services so as to meet the needs of this clientele. In the Acute Care of Elders Unit [5,17,18], the physical surroundings are adapted, a preventive and interdisciplinary approach is applied, without, the geriatric team being the sole treatment team. These units characteristically admit a frail population with at least one inability to perform the activities of daily living (ADL), but that must present the potential to benefit from the intervention. Discharge planning is the rule and pertinent patient information is transmitted to the primary care team

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