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.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Caplan GA,Williams AJ,Daly B,Abraham Kdoi
10.1111/j.1532-5415.2004.52401.xsubject
Has Abstractpub_date
2004-09-01 00:00:00pages
1417-23issue
9eissn
0002-8614issn
1532-5415pii
JGS52401journal_volume
52pub_type
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journal_title:Journal of the American Geriatrics Society
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abstract:OBJECTIVES:To determine the association between interleukin-6 (IL-6), IL-6 soluble receptor (sR), and soluble tumor necrosis factor receptor-1 (sTNF-R1) and cognitive status in the oldest-old women. DESIGN:Twenty-year longitudinal cohort study. SETTING:Four clinical sites in the United States. PARTICIPANTS:Women fro...
journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.2005.53257.x
更新日期:2005-05-01 00:00:00
abstract::Thyroid disease in the aged, both hypothyroidism and hyperthyroidism, may be subtle or may be present with no clinical symptoms and signs, and is therefore difficult to diagnose on the basis of clinical evaluation. The help of the laboratory is essential in making the diagnosis of disease of the thyroid. Therapeutic s...
journal_title:Journal of the American Geriatrics Society
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abstract:BACKGROUND/OBJECTIVE:Delirium in the intensive care units (ICUs) is prevalent, with both delirium duration and delirium severity associated with adverse outcomes. We designed a pragmatic trial to test the efficacy of a pharmacological management of delirium (PMD) bundle in improving delirium/coma-free days and reducing...
journal_title:Journal of the American Geriatrics Society
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abstract:OBJECTIVES:To determine the relationship between frailty and overall and cardiovascular mortality. DESIGN:Longitudinal mortality analysis. SETTING:National Health and Nutrition Examination Survey (NHANES) 1999-2004. PARTICIPANTS:Community-dwelling older adults aged 60 and older (N = 4,984; mean age 71.1 ± 0.19, 56% ...
journal_title:Journal of the American Geriatrics Society
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doi:10.1111/jgs.15220
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doi:10.1111/j.1532-5415.2012.04193.x
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更新日期:2006-10-01 00:00:00
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更新日期:2001-01-01 00:00:00
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doi:10.1111/jgs.12313
更新日期:2013-07-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1532-5415.2005.53502.x
更新日期:2005-10-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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更新日期:1988-11-01 00:00:00
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doi:10.1111/j.1532-5415.1993.tb02052.x
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVES:To estimate the prevalence of obesity in elderly Americans in 2010 and to discuss the health and economic implications of these estimates. DESIGN:Three methods of generating future point-prevalence estimates using data from consecutive cross-sectional studies. SETTING:All regions of the United States. PAR...
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doi:10.1111/j.1532-5415.2004.52517.x
更新日期:2004-11-01 00:00:00
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更新日期:2008-06-01 00:00:00
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更新日期:2017-04-01 00:00:00
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pub_type: 杂志文章,meta分析,评审
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更新日期:2018-02-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1996.tb00908.x
更新日期:1996-03-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
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更新日期:2016-02-01 00:00:00
abstract:OBJECTIVES:To establish the comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults using the network meta-analysis approach. DESIGN:Systematic review and network meta-analysis. PARTICIPANTS:Individuals aged 60 and older. MEASUREMENT...
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pub_type: 杂志文章,meta分析
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更新日期:2015-05-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:1975-05-01 00:00:00
abstract:OBJECTIVES:To study whether there are any negative or positive effects of 6 months of increased fluid intake in reasonably healthy elderly men. DESIGN:Randomized trial. SETTING:Community-based. PARTICIPANTS:One hundred forty-one healthy participants aged 55 to 75. INTERVENTION:One group was given the advice to incr...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2006-03-01 00:00:00
abstract:OBJECTIVES:To examine the association between handgrip strength and mortality in older Mexican American men and women. DESIGN:A 5-year prospective cohort study. SETTING:Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS:A population-based sample of 2,488 noninstitutionalized...
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pub_type: 杂志文章
doi:10.1046/j.1532-5415.2002.50312.x
更新日期:2002-07-01 00:00:00
abstract::Physical health problems become more common as people age and are associated with a great deal of disability. Although racial and ethnic disparities have been reported in physical health, little is known about whether these disparities remain in the latest part of older adulthood. Accordingly, the current study sought...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.03033.x
更新日期:2010-10-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.2008.02008.x
更新日期:2008-12-01 00:00:00