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Evid Based Nurs 5:19 doi:10.1136/ebn.5.1.19
  • Treatment

An outpatient geriatric evaluation and management programme was more effective than usual care in preventing functional decline in high risk older adults


 
 QUESTIONS: Is an outpatient geriatric evaluation and management (GEM) programme more effective than usual care in preventing functional decline in high risk older adults? Do use and cost of healthcare services differ between groups?

Design

Randomised {allocation concealed}*, blinded (outcome assessors), controlled trial with 18 months of follow up.

Setting

Ramsey County and adjacent zip codes, Minnesota, USA.

Patients

568 patients (mean age 79 y, 56% men, 96% white) who were ≥70 years of age, community dwelling, fee for service Medicare beneficiaries, and at high risk for hospital admission and functional decline. Exclusion criteria included residence in a nursing home, illness requiring frequent physician visits, and communication barriers. Study participants (96%) or their proxies (4%) completed 97% of follow up interviews.

Intervention

294 patients were allocated to the GEM team (geriatrician, gerontological nurse practitioner, and social worker) and received an initial home visit, monthly clinic visits, and regular telephone contacts. The GEM team provided assessment and primary care services for an average of 6 months. 274 patients allocated to usual care received health …

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