Geriatric Inpatient Units in the Care of Hospitalized Frail Adults with a History of Heart Failure

Abstract

s u m m a r y Background: Frail hospitalized older adults are at risk for adverse outcomes. Previous studies have suggested benefits for inpatient geriatric management (GEM). We sought to determine whether hospitalized patients with a history of heart failure (HF) benefitted from inpatient GEM or not. Methods: We studied 309 inpatients previously diagnosed with HF who were participants in a randomized trial of geriatric evaluation and management (GEM) versus usual care (UC). The intervention involved multidisciplinary teams that provided comprehensive geriatric assessment. We evaluated health-related quality of life (HRQOL), basic activities of daily living (ADLs), health service utilization, and survival at discharge, 6 months, and 1 year post randomization. Results: GEM patients had higher mean change scores for physical function (unadjusted means: 0.17 vs. e4.67, p ¼ 0.046) and basic ADLs (1.25 vs. 0.67, p ¼ 0.003) at hospital discharge, which remained significant after adjusting for baseline HRQOL scores and in-hospital days. Outcomes were not significantly different at 1 year. Length of stay for GEM was greater than UC (24 days vs. 17 days, p ¼ 0.03), but total costs at 1 year were not different (p ¼ 0.9). Mortality rates at 1 year were high and similar (GEM 29.0%, UC 27.3%, p ¼ 0.73) in both the groups. Conclusion: Inpatient GEM was associated with better maintenance of physical function and basic ADLs at hospital discharge; however, no differences in HRQOL or survival were observed between GEM and UC at 1 year post randomization. Restructuring inpatient care models to incorporate inpatient GEM principles may be one method to optimize health-care delivery.

Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review

“…On the basis of their titles and abstracts, 80 publications were selected for full-text screening, of which 18 were included. One paper was added after reference tracking, resulting in a total of 19 publications describing 18 different studies/programs [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63 ], [64], [65], [66], [67] and [68]. Reasons for exclusion are shown in Fig.…”

“…Of the 18 studies, seven were randomized controlled trials [53], [56], [58], [59], [60], [65] and [68], five pretest-post-test studies [51], [54], [57], [62] and [67], three cluster randomized controlled trials [52], [61] and [64], two post-test only studies [55] and [63], and one was a quasi-randomized controlled trial [66] (Table 2 and Appendix 1). Sample size varied from 47 to 1682 subjects [54] and [55], and the mean sample size was 497 (SD = 465.37).…”

Chapter 4 Frailty and specific diseases

“…25 Pulignano et al carried out a randomized controlled trial among heart failure patients aged ≥70 years to determine whether patients benefit from a disease management program consisting of regular screenings, interdisciplinary intervention and patient learning. However, few have assessed baseline frailty and outcomes.…”

“…Compared with those who received usual care, the participants who received geriatric evaluation and management had better ADL scores at hospital discharge. 25 Pulignano et al carried out a randomized controlled trial among heart failure patients aged ≥70 years to determine whether patients benefit from a disease management program consisting of regular screenings, interdisciplinary intervention and patient learning. Using a modified frailty score (range 1-5) that included physical and mental components, they identified 62.4% of the sample as mildly to moderately frail (frailty score 2-3) and 16.2% as severely frail (4,5).…”

Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS)

“…Some interventions have been multidimensional, including different components, but they are poorly standardized, and not suitable for different populations or countries. A systematic review [10] highlighted only nineteen publications describing eighteen comprehensive care models for multimorbidity [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], mostly in North America, with only one in Europe [23]. They vary in the type of setting, patients, and interventions, including different components (Table 1), some describing only single features, while others multiple strategies.…”