Tags

Type your tag names separated by a space and hit enter

A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study.
J Am Geriatr Soc. 2004 Sep; 52(9):1417-23.JA

Abstract

OBJECTIVES

To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED).

DESIGN

Prospective, randomized, controlled trial with 18 months of follow-up.

SETTING

Large medical school-affiliated public hospital in an urban setting in Sydney, Australia.

PARTICIPANTS

A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups.

INTERVENTION

Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care.

MEASUREMENTS

The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)).

RESULTS

Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18-month follow-up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: -0.25 vs -0.75; P<.001; mental status questionnaire change from baseline at 12 months: -0.21 vs -0.64; P<.001).

CONCLUSION

CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit.

Authors+Show Affiliations

Post Acute Care Services, Prince of Wales Hospital, Randwick, New South Wales, Australia. g.caplan@unsw.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15341540

Citation

Caplan, Gideon A., et al. "A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly From the Emergency Department--the DEED II Study." Journal of the American Geriatrics Society, vol. 52, no. 9, 2004, pp. 1417-23.
Caplan GA, Williams AJ, Daly B, et al. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. J Am Geriatr Soc. 2004;52(9):1417-23.
Caplan, G. A., Williams, A. J., Daly, B., & Abraham, K. (2004). A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. Journal of the American Geriatrics Society, 52(9), 1417-23.
Caplan GA, et al. A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly From the Emergency Department--the DEED II Study. J Am Geriatr Soc. 2004;52(9):1417-23. PubMed PMID: 15341540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. AU - Caplan,Gideon A, AU - Williams,Anthony J, AU - Daly,Barbra, AU - Abraham,Ken, PY - 2004/9/3/pubmed PY - 2004/10/8/medline PY - 2004/9/3/entrez SP - 1417 EP - 23 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 52 IS - 9 N2 - OBJECTIVES: To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED). DESIGN: Prospective, randomized, controlled trial with 18 months of follow-up. SETTING: Large medical school-affiliated public hospital in an urban setting in Sydney, Australia. PARTICIPANTS: A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups. INTERVENTION: Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care. MEASUREMENTS: The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)). RESULTS: Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18-month follow-up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: -0.25 vs -0.75; P<.001; mental status questionnaire change from baseline at 12 months: -0.21 vs -0.64; P<.001). CONCLUSION: CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/15341540/A_randomized_controlled_trial_of_comprehensive_geriatric_assessment_and_multidisciplinary_intervention_after_discharge_of_elderly_from_the_emergency_department__the_DEED_II_study_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0002-8614&amp;date=2004&amp;volume=52&amp;issue=9&amp;spage=1417 DB - PRIME DP - Unbound Medicine ER -