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Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care.

Journal article
Authors Niklas Ekerstad
Synneve Dahlin-Ivanoff
Sten Landahl
Göran Östberg
Maria Johansson
David Andersson
Magnus Husberg
Jenny Alwin
Björn W. Karlson
Published in Clinical interventions in aging
Volume 12
Pages 1239-1249
ISSN 1178-1998
Publication year 2017
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Centre for Ageing and Health (Agecap)
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1239-1249
Language en
Links dx.doi.org/10.2147/CIA.S139230
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Other Medical Sciences

Abstract

A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services.A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services.After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052-0.164; P<0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131-0.400; P<0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085-0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395-1.178; P=0.170).Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.

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