EFFECT OF A GERIATRIC CONSULTATION TEAM ON FUNCTIONAL STATUS OF ELDERLY HOSPITALIZED-PATIENTS - A RANDOMIZED, CONTROLLED CLINICAL-TRIAL
EFFECT OF A GERIATRIC CONSULTATION TEAM ON FUNCTIONAL STATUS OF ELDERLY HOSPITALIZED-PATIENTS - A RANDOMIZED, CONTROLLED CLINICAL-TRIAL
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DOI：
10.7326/0003-4819-110-1-79
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发表时间：
1989-01-01
影响因子：
39.2
通讯作者：
COHEN, HJ
中科院分区：
文献类型：
--
作者：
MCVEY, LJ;BECKER, PM;COHEN, HJ
研究目的：评估老年会诊小组对住院老年患者功能状态的影响。设计：随机对照临床试验。单位：大学附属转诊退伍军人管理医疗中心。患者：178名75岁或以上的住院老年男性接受内科、外科和精神病学服务，但不包括重症监护室的患者。干预措施：干预组88例患者接受了多方面的评价，由一个跨学科的老年医学咨询小组组成的教师老年医学，老年医学研究员，老年临床护理专家，并在老年医学培训的社会工作者。评估结果，包括问题识别和建议，被提供给病人的医生。对照组90例，仅接受常规护理。测量和主要结果：干预组和对照组最初是相当的。主要结果变量是日常生活活动独立性指数（ADL）（Katz）。39%的总研究人群在入院时功能独立，27%需要1至3个ADL的帮助，22%需要4至6个ADL的帮助，12%完全依赖。许多患者从入院到出院没有变化：干预组，38%;对照组，39%。在干预组中，34%改善，28%下降;在对照组中，26%改善，36%下降。虽然这些变化反映了干预组有更大改善的趋势，但结果并不具有统计学意义。结论：在进入急诊医院的老年患者中，约60%有一定程度的功能障碍，三分之一有严重的功能障碍。这些患者在住院期间有进一步下降的风险。一个老年咨询小组无法改变功能下降的程度。 如要作出改善，除提供意见外，老人科单位或谘询小组可能须提供直接的预防或康复服务。
Study Objective: To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients. Design: Randomized controlled clinical trial. Setting: University-affiliated referral Veterans Administration Medical Center. Patients: One hundred and seventy-eight hospitalized elderly men 75 years or older admitted to medical, surgical, and psychiatry services, but excluding patients admitted to intensive care units. Intervention: Eighty-eight intervention group patients received multidimensional evaluation by an interdisciplinary geriatric consultation team composed of a faculty geriatrician, geriatrics fellow, geriatric clinical nurse specialist, and a social worker trained in geriatrics. Results of the evaluation, including problem identification and recommendations, were given to the patients'' physicians. Ninety control group patients received only usual care. Measurements and Main Results: Intervention and control groups were comparable initially. The major outcome variable was the Index of Independence in the Activities of Daily Living (ADL) (Katz). Thirty-nine percent of the total study population was functionally independent on admission, 27% required assistance with one to three ADL, 22% required assistance with four to six ADL, and 12% were completely dependent. Many patients remained unchanged from admission to discharge: intervention group, 38%; control group, 39%. In the intervention group, 34% improved and 28% declined; in the control group, 26% improved and 36% declined. Although these changes reflected a trend toward greater improvement in the intervention group, the results were not statistically significant. Conclusions: Among elderly patients entering an acute-care hospital, approximately 60% had some degree of, and one third had serious functional disability. Such patients are at risk for further decline during hospitalization. A geriatric consultation team was unable to alter the degree of functional decline. Geriatric units or consultation teams may have to offer direct preventive or restorative services in addition to advice if improvements are to be made.