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Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months.

Abstract：

OBJECTIVE:To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. DESIGN:Randomized, controlled, assessor-blinded, single-center trial. SETTING:A geriatric ambulatory unit in a municipality in the southeast of Sweden. PARTICIPANTS:Community-dwelling individuals aged ≥ 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG). INTERVENTION:Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care. OUTCOME MEASURES:Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months. RESULTS:Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P = .026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P = .01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P = .43). CONCLUSIONS:CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGA's superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs.

journal_name

J Am Med Dir Assoc

journal_title

Journal of the American Medical Directors Association

authors

Ekdahl AW,Alwin J,Eckerblad J,Husberg M,Jaarsma T,Mazya AL,Milberg A,Krevers B,Unosson M,Wiklund R,Carlsson P

doi

10.1016/j.jamda.2015.12.008

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

263-8

issue

eissn

1525-8610

issn

1538-9375

pii

S1525-8610(15)00758-6

journal_volume

pub_type

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Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months.