Geriatric Consultation Service Research Articles

The impact of an integrative healthcare system on longevity in a nonagenarian population in Northern Mexico: an observational study

BackgroundDespite the growth in the older population, there is a noticeable research gap regarding integrative health systems for older people and their impact on longevity in nonagenarians. This study aimed to evaluate the effect of an integrative health system consisting of medical services, recreational facilities, and housing on longevity in a population of nonagenarians in Northern Mexico.MethodsThis was a cross-sectional, retrospective, descriptive-analytical study in which we measured and analyzed medical history such as number of hospitalizations, visits to geriatric consultation, hypertension, history of chronic pain, polypharmacy, dementia, rheumatic disease, diabetes mellitus, insomnia, depression, ischemic cardiomyopathy, among others. We also measured social engagement and number of caregivers. A logistic regression was performed to evaluate the predictors of mortality in this population.ResultsWe included one hundred and ninety-five nonagenarians with a mean (SD) age of 94 (4.2) years and of which 112 (55.7%) were female. The findings from logistic regression analysis indicated that a higher frequency of hospitalizations was associated with an elevated mortality risk (OR = 1.272, p = 0.049). Conversely, increased visits to geriatric consultation services as primary care were linked to a reduced mortality risk (OR = 0.953, p = 0.002). Additionally, social engagement displayed a protective effect (OR = 0.336, p = 0.05).ConclusionsThis study highlighted the role of systemic health approaches in extending life through insights into nonagenarian patients’ involvement in primary care, as measured by consultation frequency, and participation in social activities, mitigating mortality risks. Meanwhile, it emphasized the potential consequences of higher hospitalization rates on increased mortality risk.

Building Geriatric Trauma Programs in Resource-Constrained Environments: Trauma Quality Improvement Program Guideline Implementation at Two Safety Net Hospitals in Southern California.

Background: To improve care of geriatric trauma patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) updated guidelines in 2021. Amid geriatrician shortages in Southern California, 2 Los Angeles County safety net hospitals were tasked with creating a strategy to meet geriatric trauma guidelines despite constrained resources. Methods: All trauma patients ≥ 60years admitted to a safety net hospital in Southern California were enrolled without exclusions (August 2022-April 2023). Primary outcome was frailty screening with documentation to identify older trauma patients at a high risk for adverse outcomes. Results: Needs assessment discovered no standardized process to identify high-risk geriatric patients, no geriatric care guidelines, and no inpatient geriatric consultation service. An action plan composed of a resident-led frailty screen resulted in identification of high-risk patients. Overall, 217 patients met criteria. Ninety-six patients (44%) successfully underwent frailty screening. Frailty screening compliance increased over the study, beginning at 37% capture in the first month and increasing to 81% in the final study month. After achieving nearly uniform frailty screening, a form was developed for the EMR for ease of documentation, data capture/tracking, and compliance monitoring. Discussion: In this study, creativity, collaboration, and resourcefulness allowed TQIP guideline implementation at 2 county hospitals. A systematic process is now in place to identify and triage high-risk geriatric trauma patients based on frailty screen to receive inpatient medicine consultation for medical comorbidity optimization. Continued interdisciplinary and interfacility collaboration will be crucial for continued delivery of the optimal care to older injured patients.

Addressing Access to Care in Geriatric Psychiatry through Outpatient Consultation

<h3>Introduction</h3> Article 31 clinics, under the regulation of the Office of Mental Health, have limitations in the patients that are able to be seen. In particular, patients with a primary diagnosis of neurocognitive disorder are considered ineligible for admission to such a clinic. Furthermore, many of the patients that would seek treatment at Montefiore Medical Center's Outpatient Psychiatry clinic, an Article 31 clinic, would not be able to afford private practice psychiatrists. Nevertheless, older adults with neurocognitive disorder experience symptoms that are typically managed by psychiatrists. In response to this gap in care, the Outpatient Geriatric Psychiatry team at Montefiore Medical Center developed an outpatient psychiatric consultation service to increase access to care and meet the mental health care needs of older adults living in the community. This service is provided under an Article 28 clinic, which is regulated by the Department of Health like any other medical specialty clinic. In this study, we aimed to identify which patients benefited from this service, what types of interventions were made and the impact on referring providers. This was done by collecting demographic data on patients referred for consultation and the format, frequency, and outcomes of these consultations. We also plan to collect feedback from referring providers. <h3>Methods</h3> The Geriatric Psychiatry outpatient consultation service started in December 2019 and conducted visits in person for 3 months, stopped during the 3 months of lockdown due to the COVID-19 pandemic (March to June 2020), restarted with virtual visits in July 2020 and then resumed with in person visits. Patients are referred by other providers in the Montefiore Health System or through self-referral. Patients are then screened for appropriateness for outpatient consultation. Patients who are ≥65 years old or have an underlying medical condition that contributes to their frailty, and who have a psychiatric concern are scheduled for an appointment. Efforts are made to direct those who are not appropriate for the service to more appropriate resources. In a retrospective chart review, data was gathered on patient age, referral source and reason for referral, diagnosis, format and number of visits, and outcomes of interest including medication changes, supportive services, and higher level of care. <h3>Results</h3> From December 2019 through September 2021, 38 patients were scheduled, 32 of whom presented to clinic for psychiatric evaluation. Patients ranged from 61 to 93 years old with a mean age of 79 years. A majority of patients were from ethnically diverse backgrounds with 59% Hispanic, 12.5% Black, 3% Asian and 3% American Indian. 50% of patients were Spanish speaking. About half the visits were conducted in person, with the remaining visits about evenly split between phone and video. Patients on average were seen for about 2 visits with a range from 1 to 11 visits. Most of the referrals came from primary care providers and among the reasons for referral were decline in function or cognition, behavioral concerns, depressed or anxious mood and psychosis. About 87.5% of patients had a diagnosis of major or minor neurocognitive disorder diagnosis. The most common interventions included medication changes, referral to support services, behavioral interventions, transfer to the outpatient department or sending for evaluation in the emergency department. <h3>Conclusions</h3> The Geriatric Psychiatry consultation service provided through an Article 28 clinic was primarily used by patients with neurocognitive disorders who would otherwise not be seen in Article 31 outpatient psychiatry clinics and would not be able to afford private practice. Through this service we were able to address a gap in care for a diverse and underserved patient population. In order to further assess the impact of this service, we plan to ask referring providers for feedback about the process of referral, the evaluations conducted and the recommendations received for their patients. Future studies would be helpful to collect prospective data on patients being followed by consultation service and additionally obtain patient and caregiver feedback. <h3>This research was funded by</h3> N/A Chart: https://apps.aagponline.org/abstracts/uploads/2022/gpn8zt4h8w464zu.pdf

Impact of a geriatric consultation service on outcomes in older trauma patients: a before-after study.

Early geriatric involvement is recommended for older trauma patients. We wished to determine the impact of geriatric consultation on mortality, hospital length of stay and discharge disposition in older patients who were admitted to our Level 1 trauma unit. We completed a health records review of trauma unit patients, age ≥ 75years old with Injury Severity Score (ISS) ≥ 12, before (11/2015-10/2017) and after (11/2017-10/2019) implementation of a geriatric trauma consultation initiative. Primary outcomes were mortality, hospital length of stay and discharge destination. Secondary objectives were adherence to the geriatric trauma consult process and identification of geriatric-specific issues. A multivariable analysis controlling for age, gender, multi-morbidity and ISS was undertaken. 157 patients pre-implementation and 172 post-implementation with mean age 83.8years and 53.8% females were included. Geriatric consultation had no impact on in-hospital mortality [OR 0.70 (95% CI 0.31-1.58)] or length of stay [ß 0.68 (95%CI - 1.35-2.72)]. Patients who received a geriatric consultation were more likely to be discharged home (OR 2.01 (95% CI 1.24-3.24). The adherence to consultation process was 99.4%. Mobility, pain and cognitive impairment were the most common geriatric concerns, identified in 76.6, 61.1 and 50.0% of older trauma patients, respectively. Older trauma patients that receive geriatric trauma consultation are more likely to be discharged home. Collaboration between trauma and geriatric specialists is beneficial and may lead to meaningful improvements in outcomes for older trauma patients.

Quality improvement outcomes from the introduction of a geriatrician into a rehabilitation setting.

Geriatrician impact on patient and system outcomes in formal rehabilitation settings has not been well described to date. We studied the effect of adding a geriatric medicine consultation service to a geriatric focused rehabilitation setting providing care to dialysis and non-dialysis patients. A pre- and post-retrospective observational cohort study from January 1, 2009 to June 30, 2019 on all consecutively admitted adults aged 65 and older to general rehabilitation program, and adults aged 60 and older to specialized dialysis rehabilitation program, within a 25 bed general rehabilitation unit in a large urban academic rehabilitation center in Toronto, Ontario. Data were analyzed with quality improvement methodology including Statistical Process Control charts (XmR and U charts). Addition of a geriatric medicine service providing automatic comprehensive geriatric assessment and co-management consultative services for all admitted patients from admission onwards who met criteria for the intervention. The intervention commenced on August 1, 2013. Outcome measures were length of stay (days), service interruption frequency, and average functional independence measure (FIM) change (discharge FIM minus admission FIM) which uses the validated FIM score, a marker of functional ability. A 22 point change in FIM score is clinically relevant. Patient characteristics: general rehabilitation patients (n=1395, mean age=79.7, 50.1% female) and dialysis rehabilitation patients (n=838, mean age=72.8, 41.8% female). The average FIM change following intervention improved from 20.8 to 29.3 in the general rehabilitation cohort (40.6% improvement, SD=5.51) and from 22.1 to 30.6 in the dialysis rehabilitation cohort (38.6% improvement, SD=5.88). Changes in length of stay (24.9%-28.1% reduction) and service interruption frequency (34.3%-49.7% reduction) were also observed. Introduction of a geriatric medicine service for rehabilitation inpatients was associated with significant FIM score improvements. Our results suggest this intervention contributes to important gains in functional independence in reduced time for older adults receiving inpatient rehabilitative care.

Efficiency gains from a standardised approach to older people presenting to the emergency department after a fall.

Objective Falls are a major cause of hospital-related costs in people aged ≥65 years. Despite this, falls are often seen as trivial and given low priority in an emergency department (ED), especially in the absence of overt major injury. ED systems that care for falls patients are often inefficient. The aims of this study were to: (1) design and implement a standardised and systematic approach to patients presenting to an ED after a fall; and (2) achieve hospital efficiency gains, such as reduced hospital length of stay, through implementation of this approach. Methods A prospective study was conducted with pre- and postintervention measurement of outcomes. The key features of the intervention were direct admission to an ED short stay unit, standardised assessment of cognition, medications, mobility and discharge risk, and access in the ED to a geriatric consultation service for complex patients. Results In the 12 months of the intervention, 1435 male and female patients aged ≥65 years were enrolled in the study. At the end of 12 months, these patients had significantly higher ED discharge (66% vs 46%; P<0.001) and, if admitted, shorter median hospital stays (6 vs 2 days; P<0.001) compared with the baseline pre-intervention phase. Analysis 1 year later revealed that these outcomes were sustained or further improved. Conclusion A systematic approach to falls in older patients attending the ED is feasible and beneficial. Decreased hospital stay and improved rates of effective discharge from ED back to the community are achievable and sustainable. What is known about the topic? Falls are common, serious and costly. Not identifying and managing falls risk factors is a common feature of ED practice. As a result, admission rates to hospital for patients who fall are high. What does this paper add? In this large study we have shown that a systematic approach to falls assessment is feasible, sustainable and results in higher discharge rates from the ED. What are the implications for practitioners? EDs are the gateway to a hospital bed. It is possible to redesign ED flow and bring front-loaded multidisciplinary geriatric care into an ED short stay environment, to the benefit of patients and health systems.

A systematic review and meta-analysis evaluating geriatric consultation on older trauma patients.

Early involvement of geriatrics is recommended for older trauma patients. This systematic review aimed to determine the impact of a geriatric assessment on mortality, hospital length of stay, discharge destination, and delirium incidence in patients 65 years and older admitted to a trauma center. The protocol was developed according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and registered in PROSPERO (CRD42019131870). Search of five databases was completed April 2019. Two independent reviewers completed screening, full text review, and data abstraction. Meta-analysis was performed on outcomes with at least two studies. A total of 928 unique citations were identified; eight were included in the final analysis. All were cohort studies, most of moderate to poor quality using the Newcastle-Ottawa Scale. We found hospital length of stay decreased by mean of 1.11 days (95% confidence interval, 0.79-1.43), but mortality was unchanged (odds ratio, 1.01; 95% confidence interval, 0.74-1.38) in older patients admitted to a trauma center who had a geriatric consultation. Meta-analysis of discharge destination and delirium incidence was not performed due to heterogeneity. This is the first systematic review and meta-analysis to evaluate outcomes in older patients admitted to a trauma center after implementation of a geriatric trauma consultation service. We found a decrease in hospital length of stay but insufficient evidence of change in in-hospital mortality in older patients who received a geriatric consultation as part of their trauma care compared with those that received standard trauma care only. There is a need for more methodologically rigorous research in geriatric trauma. Systematic review and meta-analysis, level III.

Cost-Effectiveness Analysis of Frailty Assessment in Older Patients Undergoing Coronary Artery Bypass Grafting Surgery

BackgroundIn perioperative settings, frailty assessment has been shown to reduce mortality. This study examined the cost effectiveness of frailty assessment among patients aged 65 with coronary artery disease under consideration for coronary artery bypass grafting surgery. MethodsA combined decision tree and Markov model was developed to estimate costs and quality-adjusted life years (QALYs) over a 21-year time horizon. Clinical parameters were obtained from published literature. Utilities were derived from the literature and the Canadian Community Health Survey. Costs were obtained from the Ontario fee schedule and published literature. Sensitivity and scenario analyses were conducted to assess the robustness of the results. Expected value of perfect information (EVPI) analysis was conducted to estimate the value of further research. ResultsThe frailty assessment initiative had a lower average cost than no frailty assessment ($19,567 compared with $20,062). QALYs with frailty assessment were 0.47 years more than with no frailty assessment. Thus, frailty assessment was dominant compared with no frailty assessment. Results were robust to changes in the input parameters. At a willingness to pay (WTP) threshold of $50,000/QALY, there was 100% probability of frailty assessment being cost-effective, and the EVPI per patient was $0. Scenario and sensitivity analysis showed frailty screening remained cost effective when changing the cohort average age, removing health benefits for nonfrail patients, and using subjective judgement to modify effectiveness parameters. ConclusionsFrailty assessment may be good value for money. However, limited availability of geriatric consultation services, may hinder implementation. Thus, the estimated benefits of frailty screening may not be achievable in practice.

GeriMedRisk, a telemedicine geriatric pharmacology consultation service to address adverse drug events in long-term care: a stepped-wedge cluster randomized feasibility trial protocol (ISRCTN17219647)

BackgroundMultimorbidity, polypharmacy, and older age predispose seniors to adverse drug events (ADE). Seniors with an ADE experience greater morbidity, mortality, and health care utilization compared to their younger counterparts. To mitigate and manage ADEs among this vulnerable population, we designed a geriatric pharmacology consultation service connecting clinicians with specialist physicians and pharmacists and will investigate the feasibility and acceptability of this complex intervention in the long-term care setting, prior to conducting a larger efficacy trial.Methods/DesignWe will conduct a cluster randomized feasibility trial and qualitative analysis of GeriMedRisk among four long-term care homes in the Waterloo-Wellington region from May 1 to December 31, 2017. The primary outcome is the feasibility and acceptability of GeriMedRisk and the stepped-wedge cluster randomized controlled trial design. We hypothesize that GeriMedRisk is a feasible intervention and its potential to decrease falls and drug-related hospital visits can be evaluated with a stepped-wedge cluster randomized controlled trial design.DiscussionThis mixed methods study will inform a larger efficacy trial of GeriMedRisk’s ability to decrease adverse drug events among seniors in the long-term care setting.Ethics and disseminationThe Hamilton Integrated Research Ethics Board granted the approval for this study protocol 2812. We plan to disseminate the results of this study in peer-reviewed journals and also to our partners and stakeholders.Trial registrationISRCTN clinical trials registry, ISRCTN17219647 (March 27, 2017)

Pre- and postoperative management of risk factors for postoperative delirium: who is in charge and what is its essence?

Postoperative delirium (POD) is an adverse clinical outcome characterized by cognitive, affective and behavioral symptoms with typically an acute onset and a fluctuating course. POD is attributed to certain patients' predisposing factors as well as to treatment-related precipitating factors. While there are several single-component interventions for the prevention of POD, evolving evidence suggests the importance of a system approach in the prevention of POD. This involves strategies by multidisciplinary teams with additional geriatric consultation services to identify risk factors for POD and to modify their impact on the perioperative course. Some patients may profit from postponing an elective surgery and undergoing a prehabilitation program to optimize his/her resilience for the surgical and anesthesiologic stressors.

Impact of geriatric consultations on clinical outcomes of elderly trauma patients: A retrospective analysis

IntroductionThe elderly account for a large proportion of morbidity and mortality secondary to trauma, despite lower-energy mechanisms of injury and fewer trauma admissions. The benefit of geriatric trauma consultation services (GTCS) to this population remains unclear. MethodsWe performed a retrospective cohort analysis of a GTCS, which was established in January 2015. Patients over 60 admitted to the trauma service from January of 2014 to February 2016 were eligible. ResultsThere were no significant differences in 30-day and in-hospital mortalities, mean ICU and total lengths of stay, or complication rates. However, if a single complication was experienced, post-GTCS patients were nearly three times more likely to experience multiple complications. More patients in the GTCS group were discharged home, but were readmitted four times more often. ConclusionsA mandatory GTCS was not associated with improved patient outcomes, suggesting that management exclusively by the trauma team is at least equally effective in treatment of geriatric trauma.

Bridging the Gap: Geriatric Telepsychiatry Consultations to a Rural PACE Program

The older adult population is growing. Limited numbers and access to trained geriatric psychiatrists hinder access to timely and appropriate geriatric mental health care, particularly in rural areas. Programs for All-Inclusive Care of the Elderly (PACE) provide person-centered care to nursing home-eligible community-dwelling elderly, in whom mental health conditions including dementia and depression are highly prevalent. However, access to mental health care across PACE programs remains an under-resourced need. Telepsychiatry, the exchange of health care-related information and delivery of psychiatric services using videoconferencing technology (VCT) from a distance is one vehicle to reduce this barrier. The Institute of Medicine has identified the importance of telehealth technologies to enhance access to and quality care for older adults, particularly those in rural areas of the USA. This report describes the development and implementation of a geriatric telepsychiatry consultation service between an academic medical center and a rural PACE program.

Sustainability of a proactive geriatric trauma consultation service

Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012-December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.

Geriatric Consultation Services for Surgical Patients

Geriatric Consultation Services for Surgical Patients

Geriatric consultation service in emergency department

Geriatric consultation service in emergency department

The effectiveness of nursing management on improving health outcomes for hospitalized older adults with delirium: A systematic review protocol

The objective of this systematic review is to identify the best available research evidence related to the effectiveness of nursing management on improving health outcomes for hospitalized older adults with delirium. The specific review questions to be addressed are: What is the effectiveness of nursing interventions on: Ÿ reducing the duration, severity and incidence of delirium? Ÿ reducing the decline in cognitive status and functional status? Ÿ reducing mortality? Ÿ reducing length of hospital stay in hospitalized older adults? Specific nursing interventions include: systematic detection/screening of delirium, systematic geriatric or psychiatric consultation or consultation services by a geriatric nurse specialist, follow-up by a nurse, nursing intervention protocol designed for delirious patients, music therapy, and scheduled pain medication protocol. Inclusion criteria Types of participants Older adults aged 65 or above being admitted into acute care hospitals. Those with communication barriers such as aphasia or delirium due to substance abuse will be excluded. Types of intervention(s) For the purpose of this review, nursing management is defined as any interventions that are coordinated, led or delivered by nursing staff aiming to reduce the duration, severity, incidence, and decline on cognitive and functional status, mortality and length of hospital stay on admitted older patients with delirium. The interventions include: -a systematic screening of all admitted older adults for delirium -an intervention protocol on environmental control, patient orientation, familiarity to the environment, communication with patients and patient activities -a consultation service to geriatric or psychiatric specialist to give advice on individualized care -an alteration on care system from task-oriented to patient oriented -a scheduled pain medication protocol -music therapy according to the patients need throughout their hospitalization. Studies with multi-components or single intervention will be included in the review and a subgroup analysis will be performed. The comparator is the usual care that was done in the hospital. For detection of delirium in a usual care setting, detection of delirium relies on diagnosis by a psychiatrist or physician upon referral when agitation and disorientation are sensed by nurses. The consultation service can only be referred by physicians in-charge. No treatment plan or music therapy was designed. No standardized pain medication protocol was established. Pain medication regimen is different according to the preference of physicians. Types of outcomes The primary outcome for quantifying the effect of the interventions is the duration, severity and incidence of delirious older adults admitted to hospital. Diagnostic criteria according to the DSM-IV-TR will be adopted in evaluating the incidence of delirium. Severity of delirium will be measured by the Delirium index. The secondary outcome of interest is on the cognition and functional status, mortality and the length of hospital stay of the participants. Cognitive status will be measured by using scales such as Mini-Mental State Examination (MMSE). Functional status will be measured by using tools such as and Katz Index of Independence in Activities of Daily Living (ADL) index.

An Evaluation of a Proactive Geriatric Trauma Consultation Service

To describe and evaluate an inpatient geriatric trauma consultation service (GTCS). Delays in recognizing the special needs of older trauma patients may result in suboptimal care. The GTCS is a proactive geriatric consultation model aimed at preventing and managing age-specific complications and discharge planning for all patients 60 years or older admitted to the St Michael's Hospital Trauma Service. This was a before and after case series of patients admitted pre-GTCS (March 2005-August 2007) and post-GTCS (September 2007-March 2010). Study data were derived from a review of the medical records and from the St Michael's Hospital trauma registry. Abstracted data included demographics, type of geriatric issues addressed, rate of adherence to recommendations made by the GTCS, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests, and discharge destinations. A total of 238 pre-GTCS patients and 248 post-GTCS patients were identified. The rate of adherence to recommendations made by the GTCS team was 93.2%. There were fewer consultation requests made to Internal Medicine and Psychiatry in the post-GTCS group (N = 31 vs N = 18, P = 0.04; and N = 33 vs N = 18, P = 0.02; respectively). There were no differences in any of the prespecified complications except delirium (50.5% pre-GTCS vs 40.9% post- GTCS, P = 0.05). Among patients admitted from home, fewer were discharged to long-term care facilities among the post-GTCS group (6.5% pre-GTCS vs 1.7% post-GTCS, P = 0.03). A proactive geriatric consultation model for elderly trauma patients may decrease delirium and discharges to long-term care facilities. Future studies should include a multicenter randomized trial of this model of care.

Geriatric consultation service in emergency department: how does it work?

BackgroundHong Kong is having a significant prevalence of geriatric patients who usually require admission after presentation to the hospital through emergency departments. The geriatric consultation programme ‘We Care’ aims at...

Benefits of active participation of family physicians in geriatric consultations

Geriatric consultation services are generally beneficial in improving the health and well-being of the elderly. We prospectively studied whether the active participation of family physicians (FPs) in the process of geriatric consultation would improve implementation rates and benefit the health care of the elderly. We carried out a comparative prospective intervention study in three urban academic family medicine clinics. Patients in the control clinics were evaluated by the consultant geriatrician, and a summary of the findings and recommendations were presented to the FP in a brief meeting. In the intervention clinic, the referring FP joined the geriatrician throughout the geriatric assessment. The percentage of implementation of suggested recommendations was evaluated. Information regarding the utilization of health services was provided from computerized data. Of the 212 patients included in the study, 107 were in the intervention group and 105 were controls. The overall rate of implementation was significantly higher for patients in the intervention group (329/445; 73.9%) than for patients in the control group (232/387; 59.9%), P < 0.0001. In the year after the geriatric assessment, those in the intervention group visited the FP less often. A model co-consultation actively involving the FP in the process of assessment of the older patient by the geriatrician improves the degree of implementation of recommendations without an increase in related heath care utilization and costs. This model should be further developed and studied.

Healthcare Information System and Data Mining

This paper is to integrate information technology and medical-related technologies to develop a healthcare information system for comprehensive geriatric assessment. This system not only can process geriatric consultation services and ensure that all patient’s information are stored in standardized format , but also provide medical personnel for statistical analysis and processing purposes. This paper uses the Apriori algorithm of data mining for helping doctors to find out the relationship of geriatric syndrome. The systems of this paper can improve increase the timeliness and accuracy of patient care and administration information, increase service capacity, reduce personnel costs, and improve the quality of patient care in geriatric medicine. Furthermore, making the theories and applications of medical informatics will be more extensive and convenient for researcher and healthcare-related industry.