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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

Ekdahl, Anne W LU ; Alwin, Jenny; Eckerblad, Jeanette; Husberg, Magnus; Jaarsma, Tiny; Mazya, Amelie Lindh; Milberg, Anna; Krevers, Barbro; Unosson, Mitra and Wiklund, Rolf, et al. (2016) In Journal of the American Medical Directors Association 17(3). p.8-263
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:... (More)

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.

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publication status
published
keywords
Aged, Aged, 80 and over, Ambulatory Care, Costs and Cost Analysis, Female, Frail Elderly, Geriatric Assessment, Humans, Male, Outcome Assessment (Health Care), Single-Blind Method, Sweden, Randomized Controlled Trial
in
Journal of the American Medical Directors Association
volume
17
issue
3
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:84955446178
ISSN
1525-8610
DOI
10.1016/j.jamda.2015.12.008
language
English
LU publication?
no
id
27a5aeb4-b209-4d40-8bcb-4e5091e3f6dc
date added to LUP
2017-04-30 15:03:34
date last changed
2017-11-05 05:16:46
@article{27a5aeb4-b209-4d40-8bcb-4e5091e3f6dc,
  abstract     = {<p>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.</p><p>DESIGN: Randomized, controlled, assessor-blinded, single-center trial.</p><p>SETTING: A geriatric ambulatory unit in a municipality in the southeast of Sweden.</p><p>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).</p><p>INTERVENTION: Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care.</p><p>OUTCOME MEASURES: Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months.</p><p>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).</p><p>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.</p>},
  author       = {Ekdahl, Anne W and Alwin, Jenny and Eckerblad, Jeanette and Husberg, Magnus and Jaarsma, Tiny and Mazya, Amelie Lindh and Milberg, Anna and Krevers, Barbro and Unosson, Mitra and Wiklund, Rolf and Carlsson, Per},
  issn         = {1525-8610},
  keyword      = {Aged,Aged, 80 and over,Ambulatory Care,Costs and Cost Analysis,Female,Frail Elderly,Geriatric Assessment,Humans,Male,Outcome Assessment (Health Care),Single-Blind Method,Sweden,Randomized Controlled Trial},
  language     = {eng},
  month        = {03},
  number       = {3},
  pages        = {8--263},
  publisher    = {Elsevier},
  series       = {Journal of the American Medical Directors Association},
  title        = {Long-Term Evaluation of the Ambulatory Geriatric Assessment : A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months},
  url          = {http://dx.doi.org/10.1016/j.jamda.2015.12.008},
  volume       = {17},
  year         = {2016},
}