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Farrell TW, Volden TA, Butler JM, Eleazer GP, Rupper RW, Echt KV, Shaughnessy M, Supiano MA. Age-friendly care in the Veterans Health Administration: Past, present, and future. J Am Geriatr Soc 2023; 71:18-25. [PMID: 36254360 DOI: 10.1111/jgs.18070] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
The Veterans Health Administration (VHA) has long recognized the need for age-friendly care. VHA leadership anticipated the impact of aging World War II veterans on VA healthcare systems and in 1975 developed Geriatric Research, Education, and Clinical Centers (GRECCs) to meet this need. GRECCs catalyzed a series of innovations in geriatric models of care that span the continuum of care, most of which endure. These innovative care models also contributed to the evidence base supporting the present-day Age-Friendly Health Systems movement, with which VHA is inherently aligned. As both a provider of and payor for care, VHA is strongly incentivized to promote coordination across the continuum of care, with resultant cost savings. VHA is also a major contributor to developing the workforce that is essential for the provision of age-friendly care. As VHA continues to develop and refine innovative geriatric models of care, policymakers and non-VHA health care systems should look to VHA programs as exemplars for the development and implementation of age-friendly care.
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Affiliation(s)
- Timothy W Farrell
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatrics Research, Education, and Clinical Center (GRECC), Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Tiffany A Volden
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Jorie M Butler
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatrics Research, Education, and Clinical Center (GRECC), Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Biomedical Informatics, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - G Paul Eleazer
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatrics Research, Education, and Clinical Center (GRECC), Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Randall W Rupper
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Geriatrics Research, Education, and Clinical Center (GRECC), Salt Lake City, Utah, USA.,VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Katharina V Echt
- VA Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama, USA and Decatur, Georgia, USA.,Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marianne Shaughnessy
- Office of Geriatrics and Extended Care, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA
| | - Mark A Supiano
- Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
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Ratner ER, Kilaberia TR, Englund J, Fink HA. An evaluation of a sustained senior mentor program for medical students. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:418-428. [PMID: 33726637 DOI: 10.1080/02701960.2021.1899918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background/Objective Medical student geriatrics education using community-based volunteer older persons, known as a Senior Mentor Program (SMP), began decades ago. Though these programs have been described and evaluated against curriculum objectives, the full breadth of students' learning from SMPs has not been reported. Methods We conducted a qualitative study using content analysis of reflections of Year 2 medical students submitted during a single visit home-based SMP. Written reflections of 102 randomly selected students from 2016-2018 were inductively coded and grouped into themes. Older persons from the SMP site assisted in coding and quotation selection. Results We discerned six themes from the evaluation of student reflections: student insight, interview and exam, social community, challenges with aging, strengths (responses to challenges), and physical infrastructure. Conclusion A single home visit with older adults enables pre-clinical medical students to learn about multiple positive aspects of aging.
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Affiliation(s)
- Edward R Ratner
- Department of Medicine, University of Minnesota Medical School, USA
- Minneapolis Veterans Administration Health Care System Geriatrics Research Education and Clinical Center (GRECC), USA
| | - Tina R Kilaberia
- Betty Irene Moore School of Nursing University of California Davis Health, USA
| | | | - Howard A Fink
- Department of Medicine, University of Minnesota Medical School, USA
- Minneapolis Veterans Administration Health Care System Geriatrics Research Education and Clinical Center (GRECC), USA
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Brunette AM, Rycroft SS, Colvin L, Schwartz AW, Driver JA, Nothern A, Harrington MB, Jackson CE. Integrating Neuropsychology into Interprofessional Geriatrics Clinics. Arch Clin Neuropsychol 2022; 37:545-552. [PMID: 34718368 PMCID: PMC9630824 DOI: 10.1093/arclin/acab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Interprofessional healthcare teams are increasingly viewed as a clinical approach to meet the complex medical, psychological, and psychosocial needs of older adult patients. Despite the fact that older adults are at risk for cognitive difficulties, neuropsychologists are not routinely included on Geriatrics consult teams. The primary aim of this paper is to highlight the utility of neuropsychology within an interprofessional Geriatrics consult clinic. To address this aim, we describe specific benefits to patient care that may be associated with the inclusion of neuropsychologists on Geriatrics consult teams, including differential diagnosis, enhanced patient care, and reduced barriers to care. We provide a description of the integration of neuropsychology within a Veterans Health Administration (VA) interprofessional Geriatrics consult clinic team in order to illustrate the implementation of this model.
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Affiliation(s)
- Amanda M. Brunette
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA,Corresponding author at: The University of Kansas Health System, 4330 Shawnee Mission Pkwy Suite 2180, Fairway, KS 66205, USA. Tel.: 913-588-6973; Fax: 913-588-6964. (A.M. Brunette)
| | | | - Leigh Colvin
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA,Harvard Medical School, Department of Medicine, Boston, MA, USA,Brigham & Women’s Hospital, Division of Aging, Boston, MA, USA
| | - Jane A. Driver
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA,Harvard Medical School, Department of Medicine, Boston, MA, USA,Brigham & Women’s Hospital, Division of Aging, Boston, MA, USA
| | - Alexandra Nothern
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA
| | - Mary Beth Harrington
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA
| | - Colleen E. Jackson
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Puts MT, Alibhai SM. Fighting back against the dilution of the Comprehensive Geriatric Assessment. J Geriatr Oncol 2018; 9:3-5. [DOI: 10.1016/j.jgo.2017.08.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/16/2017] [Indexed: 11/16/2022]
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Affiliation(s)
- Harvey Jay Cohen
- Department of Medicine; Duke Center for the Study of Aging and Human Development; Duke University Medical Center; Durham North Carolina
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Supiano MA, Alessi C, Chernoff R, Goldberg A, Morley JE, Schmader KE, Shay K. Department of Veterans Affairs Geriatric Research, Education and Clinical Centers: translating aging research into clinical geriatrics. J Am Geriatr Soc 2012; 60:1347-56. [PMID: 22703441 DOI: 10.1111/j.1532-5415.2012.04004.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Department of Veterans Affairs (VA) Geriatric Research, Education and Clinical Centers (GRECCs) originated in 1975 in response to the rapidly aging veteran population. Since its inception, the GRECC program has made major contributions to the advancement of aging research, geriatric training, and clinical care within and outside the VA. GRECCs were created to conduct translational research to enhance the clinical care of future aging generations. GRECC training programs also provide leadership in educating healthcare providers about the special needs of older persons. GRECC programs are also instrumental in establishing robust clinical geriatric and aging research programs at their affiliated university schools of medicine. This report identifies how the GRECC program has successfully adapted to changes that have occurred in VA since 1994, when the program's influence on U.S. geriatrics was last reported, focusing on its effect on advancing clinical geriatrics in the last 10 years. This evidence supports the conclusion that, after more than 30 years, the GRECC program remains a vibrant "jewel in the crown of the VA" and is poised to make contributions to aging research and clinical geriatrics well into the future.
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Affiliation(s)
- Mark A Supiano
- Division of Geriatric Medicine, School of Medicine, University of Utah, Salt Lake City, Utah 84148, USA.
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Geriatric Education for Elder Justice. J Elder Abuse Negl 2008. [DOI: 10.1300/j084v14n02_08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Warshaw GA, Bragg EJ, Freyberg RW. Geriatric medicine and geriatric psychiatry clinical services affiliated with U.S. academic medical centers. J Am Geriatr Soc 2006; 54:690-5. [PMID: 16686884 DOI: 10.1111/j.1532-5415.2006.00655.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).
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Affiliation(s)
- Gregg A Warshaw
- Office of Geriatric Medicine, Department of Family Medicine, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University, VA Medical Center, 1402 S. Grand Blvd., M238, St. Louis, MO 63104, USA.
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Selim AJ, Berlowitz DR, Fincke G, Cong Z, Rogers W, Haffer SC, Ren XS, Lee A, Qian SX, Miller DR, Spiro A, Selim BJ, Kazis LE. The Health Status of Elderly Veteran Enrollees in the Veterans Health Administration. J Am Geriatr Soc 2004; 52:1271-6. [PMID: 15271113 DOI: 10.1111/j.1532-5415.2004.52355.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the health status of elderly veteran enrollees, stratified by age group, and compare with nonveteran populations. DESIGN Cross-sectional study. SETTING Outpatient. PARTICIPANTS A total of 1,406,049 veteran enrollees were surveyed, and 887,775 returned the questionnaire (63.1%). Of these, 663,729 (74%) were aged 65 and older. MEASUREMENTS Patient demographics, comorbid conditions, and health status, which was assessed using the Veterans 36-item short form (SF-36), a reliable and valid measure of health-related quality of life (HRQoL). RESULTS Elderly veteran enrollees are a group with poor health status across all scales of the Veterans SF-36. Significant decline in HRQoL was found in patients grouped by increasing age (65-74, 75-84, and > or =85). Of the Veterans SF-36 scales, the role physical and role emotional scales and physical functioning presented the largest decrements by age group. The elderly veteran enrollees had poorer health status than older people enrolled in Medicare managed care, ranging from 0.5 to 1 standard deviations worse. CONCLUSION Elderly veteran enrollees have substantial disease burden, as reflected by major impairments across multiple dimensions of HRQoL. These findings bear important implications for use of services, suggesting that the Veterans Health Administration will require considerable resources to provide care for its aging population.
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Affiliation(s)
- Alfredo J Selim
- Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs (VA) Medical Center, Bedford, Massachusetts, USA.
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Salerno JA, Cooley SG. Tribute to Marsha Goodwin-Beck, RN-C, MA, MSN. J Am Geriatr Soc 2004. [DOI: 10.1111/j.1532-5415.2004.52189.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Warshaw GA, Bragg EJ. The training of geriatricians in the United States: three decades of progress. J Am Geriatr Soc 2003; 51:S338-45. [PMID: 12823665 DOI: 10.1046/j.1365-2389.2003.51345.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the past 3 decades, significant progress has been made in preparing U.S. physicians to care for the growing elderly population. This paper reviews progress in training and certifying internists and family physicians in geriatric medicine. The establishment of the National Institute on Aging, a series of Institute of Medicine reports, Veterans Health Administration initiatives, and leadership and investment by the public sector and private foundations have supported the development of geriatric medicine training programs. In 1988, the Accreditation Council for Graduate Medical Education initially accredited 62 internal medicine (IM) and 16 family practice (FP) geriatric medicine fellowship programs. By academic year 2001-2002, 120 geriatric medicine fellowships were training 338 fellows. A recent survey of U.S. medical schools found a total of 869 full-time equivalent (FTE) geriatrics faculty members. Their geriatrics programs had a median of 5.0 FTE physician faculty members, with a range of 0 to 42. Recent surveys of IM and FP residency programs found 803 geriatrician faculty members teaching in IM residency programs (53% response rate) and 453 teaching in FP residency programs (75% response rate). From 1988 through 2002, 10,207 Certificates of Added Qualifications in Geriatrics were awarded. The distribution of these practicing geriatricians varied considerably by state, with the national average being 5.5 per 10,000 persons aged 75 and older. Individual state rates ranged from 2.2 to 15.9. Although geriatric medicine training has grown remarkably over the past 3 decades, this growth is still not producing the number of geriatricians needed to care for the growing elderly population. Thus, expanded investment in the training of geriatricians as faculty and practitioners is needed.
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Affiliation(s)
- Gregg A Warshaw
- Office of Geriatric Medicine and Department of Family Medicine, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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Evolution of Geriatric Medicine Fellowship Training in the United States. THE AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY 2003. [DOI: 10.1097/00019442-200305000-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Walker RF, Bercu BB. Issues Regarding the Routine and Long-Term Use of Growth Hormone in Anti-Aging Medicine. ACTA ACUST UNITED AC 2001. [DOI: 10.1089/10945450152850623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Richard F. Walker
- Departments of Biochemistry and Molecular Biology, and Pediatrics, University of South Florida, Tampa, Florida
| | - Barry B. Bercu
- Departments of Pediatrics, and Pharmacology and Therapeutics, University of South Florida, Tampa, Florida
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15
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Malphurs FL, Striano JA. Gaze into the long-term care crystal ball: The Veterans Health Administration and aging. J Gerontol A Biol Sci Med Sci 2001; 56:M666-73. [PMID: 11682571 DOI: 10.1093/gerona/56.11.m666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Veterans Health Administration (VHA) has provided excellent care for its aging veteran population in the past and has been a leader in the development of academic geriatrics in the United States. Over the next decade we can expect to see the VHA recognize the need to integrate its services for the older veteran with those available in the community. As the VHA once again redesigns itself to meet the needs of its aging veterans, we can expect it will evolve into a model health care system for older persons that may well become the prototype for eldercare in the United States.
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Affiliation(s)
- F L Malphurs
- Geriatrics and Extended Care, VA Healthcare Network Upstate New York, Albany 12208-0980, USA.
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Rosher RB, Robinson SB, Boesdorfer D, Lee K. Interdisciplinary education in a community-based geriatric evaluation clinic. TEACHING AND LEARNING IN MEDICINE 2001; 13:247-252. [PMID: 11727391 DOI: 10.1207/s15328015tlm1304_06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Demographic predictions are challenging schools of medicine to emphasize geriatrics. This article describes a geriatric evaluation (GET) clinic and explores the opportunity for residents to attain core geriatric competencies. DESCRIPTION The GET clinic is located in a small Midwestern city associated with a community-based medical school. It is staffed by an interdisciplinary team consisting of a geriatrician, a gerontological nurse specialist, and a social worker. Residents, medical students, and nursing students are frequent participants. EVALUATION Descriptive data indicate that the clinic experience addresses the core competencies set forth by the American Geriatric Society. The clinical outcomes indicate that the clinic is effective in maintaining the functional status of patients and has a positive effect on family caregivers. Residents and students rate their experience as excellent. CONCLUSIONS The GET clinic provides a unique interdisciplinary educational opportunity. Further investigation is needed to determine if residents who participate do attain core competencies.
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Affiliation(s)
- R B Rosher
- Department of Internal Medicine, Division of Geriatrics, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Rubenstein LZ, Josephson KR, Harker JO, Miller DK, Wieland D. The Sepulveda GEU Study revisited: long-term outcomes, use of services, and costs. AGING (MILAN, ITALY) 1995; 7:212-7. [PMID: 8547380 DOI: 10.1007/bf03324318] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The randomized controlled trial of the Geriatric Evaluation Unit (GEU) at the Sepulveda Veterans Hospital was the first to document the clinical and cost-effectiveness of hospital-based comprehensive geriatric assessment (CGA). Frail elderly inpatients were assigned randomly to the GEU for CGA, therapy, rehabilitation, and placement (N = 63), or to standard hospital care (N = 60). At one year, GEU patients had much lower mortality (24% vs 48%) and were less likely to have been discharged to a nursing home (NH) (13% vs 30%), or to have spent any time in NHs (27% vs 47%). GEU patients were more likely to improve in personal self-maintenance and morale. Further, controls had substantially more acute-care hospital days, NH days, and hospital readmissions, resulting in higher direct institutional care costs, especially after survival adjustment. Here, we report the results of long-term follow-up. There was a significant survival effect through two years. Despite prolongation of life, there was no indication that quality of life was worse for survivors in the GEU group. In fact, the proportion of persons independent in > or = 2 ADLs at two years was somewhat higher for GEU patients (0.44) than controls (0.33) (z = 1.27; p = 0.056). By three years, 43% of GEU subjects and 38% of controls were still alive. Over the entire 3-year period, the per capita direct cost difference was not significant, either before or after survival adjustment (unadjusted: $37,091 GEU vs $34,205 control; survival-adjusted: $54,315 GEU vs $63,362 control; p = 0.17).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Z Rubenstein
- Geriatric Research, Education, and Clinical Center (GRECC), Sepulveda VA Medical Center, California 91343, USA
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