Effectiveness of a Geriatric Evaluation Unit

Rubenstein, Laurence Z.; Josephson, Karen R.; Wieland, G. Darryl; English, Patricia A.; Sayre, James; Kane, Robert L

doi:10.1056/nejm198412273112604

Cited by 783 publications

(469 citation statements)

References 23 publications

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“…Prior to this, frailty has primarily been evaluated in hospitalized or nursing home populations (3,4,7,8,24,46,47). Such studies, due to the selection process by which their participants arrive in these settings, are likely to characterize persons with late-stage frailty, after the occurrence of related adverse outcomes, and having highly selected correlates.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Frailty in Older Adults: Evidence for a Phenotype

Fried¹,

Tangen²,

Walston³

et al. 2001

The Journals of Gerontology Series A: Biological Sciences and M

18,609

415

19,090

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Section: Discussionmentioning

confidence: 99%

“…Numerous geriatric interventions have been developed to improve clinical outcomes for frail older adults (3)(4)(5)(6)(7). A major obstacle to the success of such interventions has been the absence of a standardized and valid method for screening of those who are truly frail so as to effectively target care (1,3).…”

mentioning

confidence: 99%

Frailty in Older Adults: Evidence for a Phenotype

Fried¹,

Tangen²,

Walston³

et al. 2001

The Journals of Gerontology Series A: Biological Sciences and M

18,609

415

19,090

View full text Add to dashboard Cite

“…7 In this 1-year follow up study, frail elderly patients undergoing GEM-model inpatient care demonstrated significantly greater improvements in functional status (48% more GEM patients with improvements on the Personal Self Maintenance Scale), fewer initial discharges to nursing homes (58% fewer), less time spent in nursing homes and acute care hospitals (mean 42% and 25% less, respectively), as well as fewer acute care hospital readmissions (30% less). 7 The GEM intervention was also associated with improved morale, much lower mortality (51% lower) and lower direct costs for institutional care (19% lower). All these benefits were sustained 1 year after the intervention.…”

Section: Inpatient Gem Interventionsmentioning

confidence: 99%

Geriatric interventions: the evidence base for comprehensive health care services for older people

Cordato

Saha²,

Price³

2005

Aust. Health Review

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Specialist geriatric services apply a comprehensive, multidisciplinary evaluation and management approach to the multidimensional and usually interrelated medical, functional and psychosocial problems faced by at-risk frail elderly people. This paper examines currently available data on geriatric interventions and finds ample evidence supporting both the efficacy and the cost-effectiveness of these specialist interventions when utilised in appropriately targeted patients. It is proposed that substantial investment in these programs is required to meet the future demands

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“…These strategies have been successfully used by others with significant results. [32][33][34][35][36][37] …”

Section: Discussionmentioning

confidence: 99%

Effect of a Practice Guideline on the Process of Emergency Department Care of Falls in Elder Patients

Baraff

Lee

Kader

et al. 1999

Academic Emergency Medicine

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Abstract. Objective: To determine the effect of a practice guideline on the process of ED care in a health maintenance organization. Methods: A prepost-intervention comparison with a one-year pre-intervention phase followed by a one-year post-educational intervention phase was used to study the effect of the guideline on ED care. Emergency physicians and nurses were provided the details of the guideline during a two-week interval between the two periods. Results: During the two years of the study, 1,140 preintervention and 759 post-intervention patients met study eligibility criteria. More patients were diagnosed as having had falls due to loss of consciousness, stroke, and seizures during the post-intervention period (pre-intervention 3.8% vs post-intervention 8.4%, p < 0.001). There was a significant improvement in documentation of six of ten history items: cause of fall (64.5% vs 72.9%), location of fall (54.7% vs 60.5%), ability to get up unassisted (5.4% vs 12.5%), long lie after fall (1.5% vs 10.1%), prescription medications (79.0% vs 92.2%), and Pneumovax immunization status (20.8% vs 43.0%); and two of the four physical examination items: visual acuity (1.5% vs 3.2%) and the ''get up and go test'' (1.3% vs 11.2%). Prescribing of calcium and vitamin D increased from 0% to 6.6%. Conclusions:The educational intervention to the practice guideline for the ED management of falls in elders led to small but significant improvements in the documentation of selected history and physical examination items and the prescribing of calcium and vitamin D, and to a greater consideration of the causes of falls. Key words: practice guidelines; accidental falls-prevention and control; aged; emergency medicine; geriatric assessment. ACADEMIC EMERGENCY MEDICINE 1999; 6:1216-1223 T HE U.S. population is growing older, with the most rapid growth among the oldest of the old.1 As a result, an increasing proportion of ED patients will be older citizens.2 Falls are a substantial problem in individuals Ն65 years of age, occurring in 32% of those 65-74, 35% of those 75-84, and 51% of those Ն85 years of age each year.3-7 Falls directly or indirectly cause 12% of all deaths in elders. 5,8 Approximately 5% of falls in older persons result in fractures and another 5-10% result in serious injuries that necessitate medical care. 9-12Though there has been considerable progress made in the evaluation and treatment of frail older citizens, recent surveys have demonstrated that practicing emergency physicians (EPs) are often uncomfortable with these patients, and attribute this to inadequacies in training, research, and continuing education in geriatric emergency medicine. 13,14 To address this issue, the Society for Academic Emergency developed a curriculum and model of care for the emergency medical treatment of elder patients. 15In a parallel attempt to improve EPs' understanding of the special problems of elders, we developed a practice guideline for the ED evaluation and treatment of falls in older persons. We chose falls because we postu...

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Effectiveness of a Geriatric Evaluation Unit

Cited by 783 publications

References 23 publications

Frailty in Older Adults: Evidence for a Phenotype

Frailty in Older Adults: Evidence for a Phenotype

Geriatric interventions: the evidence base for comprehensive health care services for older people

Effect of a Practice Guideline on the Process of Emergency Department Care of Falls in Elder Patients

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