Geriatric‐Based Versus General Wards for Older Acute Medical Patients: A Randomized Comparison of Outcomes and Use of Resources

Asplund, Kjell; Gustafson, Yngve; Jacobsson, Catrine; Bucht, Gösta; Wåhlin, Anders; Peterson, Jonas; Blom, Jan-Olof; Ängquist, Karl‐Axel

doi:10.1111/j.1532-5415.2000.tb02626.x

Cited by 149 publications

(232 citation statements)

References 16 publications

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“…11 De implementatie van de CGA resulteerde in lagere sterfte bij de ouderen na 6 maanden, maar niet na 12 maanden nazorg. 12 Multidisciplinaire interventies, inclusief lichamelijke oefening, zijn geassocieerd met een afname van functieverlies, 13,14 kortere ziekenhuisopname tegen dezelfde kosten in vergelijking met 'reguliere zorg', [13][14][15][16] minder (her)opnamen in ziekenhuizen en verpleeghuizen, [17][18][19] minder valincidenten, 15,20 en beter ervaren gezondheid en tevredenheid met het leven. 18,21,22 Deze effecten treden op tussen 6 en 12 maanden na de start van de interventies, met een piekeffect na 3 maanden.…”

Section: Achtergrondunclassified

Integrale interventie ter voorkoming van functieverlies bij ouderen tijdens ziekenhuisopname: het Zorgprogramma voor Preventie en Herstel

Vos

Asmus-Szepesi²,

Bakker

et al. 2014

Tijdschr Gerontol Geriatr

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Integrated approach to prevent functional decline in hospitalized elderlyBackground: Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age. Methods/design: To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented the Prevention and Reactivation Care Programme (PReCaP), an innovative program aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline. Discussion: This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1) Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2) Intensive follow-up treatment for a selected patient group at the prevention and Reactivation Centre; (3) Availability of multidisciplinary geriatric expertise; (4) Provision of support and consultation of relevant professionals to informal caregivers; (5) Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of forthcoming papers.

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Section: Achtergrondunclassified

Integrale interventie ter voorkoming van functieverlies bij ouderen tijdens ziekenhuisopname: het Zorgprogramma voor Preventie en Herstel

Vos

Asmus-Szepesi²,

Bakker

et al. 2014

Tijdschr Gerontol Geriatr

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“…Functional deterioration occurs early, with as many as 65% suffering a decline in mobility by day two of the hospitalisation. 3 Although inpatient geriatric programs reduce LOS, mortality, morbidity, nursing home placements, and inappropriate medication use, and improve quality of life and functional status, [12][13][14][15] many patients fail to improve. High-risk patients in particular may suffer irreversible decline before commencement of geriatric risk assessment and intervention programs.…”

Section: What Are the Implications?mentioning

confidence: 99%

A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

Basic

Conforti²

2005

Aust. Health Review

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The aim of this randomised controlled trial involving 224 elderly patients was to determine whether early geriatric assessment (in the form of an aged care nurse intervention based in the emergency department) reduced admission to the hospital, length of inpatient stay (LOS), or functional decline during the hospitalisation. Baseline geriatric assessments were recorded in the medical files of intervention patients (n = 114). The nurse also liaised with the patients' carers and health care providers, organised referrals for out-of-hospital assessment and support services, and assisted in the care of those admitted as inpatients by documenting suggestions for assessment and referral. Assessment data from control patients (n = 110) were withheld, and the nurse had no further involvement in their inpatient or outpatient care. One hundred and seventy-one patients (76%) were admitted to the hospital, for a median LOS of 10 days. The nurse successfully identified those needing admission (odds ratio [OR], 14.0; 95% confidence interval [CI], 2.6-75.1). Thirty-nine of 160 inpatients with available data (24%) had a functional deterioration during the hospitalisation. The intervention had no significant effect on admission to the hospital (OR, 0.7; CI, 0.3-1.7), LOS (hazard ratio, 1.1; CI, 0.7-1.5) or functional decline during the hospitalisation ELDERLY PERSONS VISIT the emergency department (ED) more often than younger persons. 1 They often have serious complaints that limit function and restrict their ability to live independently. For many, hospitalisation results in functional decline despite cure or repair of the condition for which they were admitted. 2,3 Functional status is a strong predictor of LOS, mortality, and nursing home placement. 4,5 Early assessment of elderly patients can identify risk factors that contribute to hospital-acquired dependency. 2,6 The best models of care for older persons visiting emergency departments are not known, and few randomised, controlled trials of interventions in the ED setting have been published. A two-stage intervention, comprising screening and a brief standardised nursing assessment and referral, reduced the rate of functional decline four months after the ED visit. 7 The beneficial outcomes resulted primarily from early provi-

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“…Ideally, the geriatric assessment should begin in the emergency department, with high risk patients referred to geriatric programs (Creditor 1993). With appropriate targeting, these programs reduce LOS, mortality, morbidity, nursing home placements, and inappropriate medication use, and improve quality of life and functional status (Flamer 1996, Stuck 1993, Asplund 2000, Cohen 2002). …”

Section: Introductionmentioning

confidence: 99%

Standardised assessment of older patients by a nurse in an emergency department

Basic

Conforti²,

Rowland³

2002

Aust. Health Review

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Geriatric‐Based Versus General Wards for Older Acute Medical Patients: A Randomized Comparison of Outcomes and Use of Resources

Cited by 149 publications

References 16 publications

Integrale interventie ter voorkoming van functieverlies bij ouderen tijdens ziekenhuisopname: het Zorgprogramma voor Preventie en Herstel

Integrale interventie ter voorkoming van functieverlies bij ouderen tijdens ziekenhuisopname: het Zorgprogramma voor Preventie en Herstel

A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department

Standardised assessment of older patients by a nurse in an emergency department

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