Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization

JAMA. 1990 Jan 26;263(4):538-44.


Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.

Publication types

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

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care / organization & administration*
  • Consumer Behavior / statistics & numerical data
  • Costs and Cost Analysis
  • Geriatric Assessment*
  • Health Maintenance Organizations / organization & administration*
  • Health Status
  • Humans
  • Internal Medicine
  • Outcome and Process Assessment, Health Care / statistics & numerical data*
  • Random Allocation
  • Referral and Consultation*
  • Rhode Island