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Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study.

Journal article
Authors Theresa Westgård
Isabelle Ottenvall Hammar
Eva Holmgren
Anna Ehrenberg
Aase Wisten
Anne W Ekdahl
Synneve Dahlin-Ivanoff
Katarina Wilhelmson
Published in Pilot and feasibility studies
Volume 4
Pages 41
ISSN 2055-5784
Publication year 2018
Published at Institute of Neuroscience and Physiology, Department of Health and Rehabilitation
Centre for Ageing and Health (Agecap)
Pages 41
Language en
Links dx.doi.org/10.1186/s40814-018-0228-...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Nursing, Physiotherapy, Health Care Service and Management, Health Policy and Services and Health Economy, Other Health Sciences, Occupational Therapy, Health Sciences, Geriatrics

Abstract

Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57].The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.Clinical Trials ID: NCT02773914. Registered 16 May 2016.

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