A Randomized Clinical Trial of Outpatient Comprehensive Geriatric Assessment Coupled With an Intervention to Increase Adherence to Recommendations

J Am Geriatr Soc. 1999 Mar;47(3):269-76. doi: 10.1111/j.1532-5415.1999.tb02988.x.

Abstract

Background: Although comprehensive geriatric assessment (CGA) has been demonstrated to confer health benefits in some settings, its value in outpatient or office settings is uncertain.

Objective: To assess the effectiveness of outpatient CGA consultation coupled with an adherence intervention on 15-month health outcomes.

Design: A randomized controlled trial.

Setting: Community-based sites.

Patients: 363 community-dwelling older persons who had failed a screen for at least one of four conditions (falls, urinary incontinence, depressive symptoms, or functional impairment)

Intervention: A single outpatient CGA consultation coupled with an intervention to improve primary care physician and patient adherence with CGA recommendations.

Measurements: Medical Outcomes Study Short Form-36 (MOS SF-36), restricted activity and bed days, Physical Performance Test, NIA lower-extremity battery.

Results: In complete case analysis (excluding the five control group subjects who died during the follow-up period), the adjusted difference in change scores (4.69 points) for physical functioning between treatment and control groups indicated a significant benefit of treatment (P = .021). Similar benefits were demonstrated for number of restricted activity days and MOS SF-36 energy/fatigue, social functioning, and physical health summary scales. In analyses assigning scores of 0 to those who died, these benefits were greater, and significant benefits for the Physical Performance Test and MOS SF-36 emotional/well being, pain, and mental health summary scales were also demonstrated.

Conclusions: A single outpatient comprehensive geriatric assessment coupled with an adherence intervention can prevent functional and health-related quality-of-life decline among community-dwelling older persons who have specific geriatric conditions.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accidental Falls / prevention & control
  • Activities of Daily Living
  • Aged
  • Ambulatory Care / organization & administration*
  • Comprehensive Health Care / organization & administration*
  • Depression / prevention & control
  • Female
  • Geriatric Assessment*
  • Humans
  • Los Angeles
  • Male
  • Patient Compliance / psychology*
  • Primary Health Care / organization & administration*
  • Program Evaluation
  • Referral and Consultation / organization & administration*
  • Urinary Incontinence / prevention & control