Geriatric inpatient units in the care of hospitalized frail adults with a history of heart failure

Shahyar Gharacholou, Richard Sloane, Harvey J. Cohen, Kenneth E. Schmader

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

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. -4.67, p = 0.046) and basic ADLs (1.25 vs. 0.67, p = 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 = 0.03), but total costs at 1 year were not different (p = 0.9). Mortality rates at 1 year were high and similar (GEM 29.0%, UC 27.3%, p = 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.

Original languageEnglish (US)
Pages (from-to)112-116
Number of pages5
JournalInternational Journal of Gerontology
Volume6
Issue number2
DOIs
StatePublished - Jun 1 2012

Fingerprint

Geriatrics
Inpatients
Heart Failure
Activities of Daily Living
Quality of Life
Random Allocation
Geriatric Assessment
Frail Elderly
Survival
Health Services
Length of Stay
Maintenance
Delivery of Health Care
Costs and Cost Analysis
Mortality

Keywords

  • frail elderly
  • geriatric assessment
  • heart failure

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Geriatric inpatient units in the care of hospitalized frail adults with a history of heart failure. / Gharacholou, Shahyar; Sloane, Richard; Cohen, Harvey J.; Schmader, Kenneth E.

In: International Journal of Gerontology, Vol. 6, No. 2, 01.06.2012, p. 112-116.

Research output: Contribution to journalReview article

Gharacholou, Shahyar ; Sloane, Richard ; Cohen, Harvey J. ; Schmader, Kenneth E. / Geriatric inpatient units in the care of hospitalized frail adults with a history of heart failure. In: International Journal of Gerontology. 2012 ; Vol. 6, No. 2. pp. 112-116.
@article{c0985f80890b4387a58d81c653c946f6,
title = "Geriatric inpatient units in the care of hospitalized frail adults with a history of heart failure",
abstract = "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. -4.67, p = 0.046) and basic ADLs (1.25 vs. 0.67, p = 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 = 0.03), but total costs at 1 year were not different (p = 0.9). Mortality rates at 1 year were high and similar (GEM 29.0{\%}, UC 27.3{\%}, p = 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.",
keywords = "frail elderly, geriatric assessment, heart failure",
author = "Shahyar Gharacholou and Richard Sloane and Cohen, {Harvey J.} and Schmader, {Kenneth E.}",
year = "2012",
month = "6",
day = "1",
doi = "10.1016/j.ijge.2012.01.012",
language = "English (US)",
volume = "6",
pages = "112--116",
journal = "International Journal of Gerontology",
issn = "1873-9598",
publisher = "Elsevier Taiwan LLC",
number = "2",

}

TY - JOUR

T1 - Geriatric inpatient units in the care of hospitalized frail adults with a history of heart failure

AU - Gharacholou, Shahyar

AU - Sloane, Richard

AU - Cohen, Harvey J.

AU - Schmader, Kenneth E.

PY - 2012/6/1

Y1 - 2012/6/1

N2 - 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. -4.67, p = 0.046) and basic ADLs (1.25 vs. 0.67, p = 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 = 0.03), but total costs at 1 year were not different (p = 0.9). Mortality rates at 1 year were high and similar (GEM 29.0%, UC 27.3%, p = 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.

AB - 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. -4.67, p = 0.046) and basic ADLs (1.25 vs. 0.67, p = 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 = 0.03), but total costs at 1 year were not different (p = 0.9). Mortality rates at 1 year were high and similar (GEM 29.0%, UC 27.3%, p = 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.

KW - frail elderly

KW - geriatric assessment

KW - heart failure

UR - http://www.scopus.com/inward/record.url?scp=84862837353&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862837353&partnerID=8YFLogxK

U2 - 10.1016/j.ijge.2012.01.012

DO - 10.1016/j.ijge.2012.01.012

M3 - Review article

AN - SCOPUS:84862837353

VL - 6

SP - 112

EP - 116

JO - International Journal of Gerontology

JF - International Journal of Gerontology

SN - 1873-9598

IS - 2

ER -