Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit: a prospective randomized trial

OBJECTIVES: Documentation of treatment effects in acutely sick frail older patients in geriatric evaluation and management units (GEMUs) is scarce. The present study evaluated whether treatment in a GEMU would reduce mortality as compared to traditional treatment delivered in the Department of Internal Medicine.

DESIGN: Prospective randomized trial.

SETTING: GEMU or general medical ward

PARTICIPANTS: Acutely sick frail patients aged 75 and older who had been admitted to the Department of Internal Medicine were randomly assigned to treatment in the GEMU (n = 127) or to the general medical wards (n = 127). The following inclusion criteria were used to target frail patients: chronic disability, acute impairment of single activity of daily living, mild/moderate dementia, confusion, depression, imbalance/dizziness, falls, impaired mobility, urinary incontinence, malnutrition, polypharmacy, vision or hearing impairment, social problems, or prolonged bedrest.

INTERVENTION: in the GEMU, the treatment strategy emphasized interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilization/rehabilitation, and comprehensive discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow-up.

MEASUREMENTS: Mortality and causes of death.

RESULTS: Mortality in the intervention and control groups, respectively, was 12% and 27% at 3 months (P = .004), 16% and 29% (P = .02) at 6 months, and 28% and 34% (P = .06) at 12 months. The hazard ratio was 0.39 (95% confidence interval = 0.21-0.72) at 3 months. The main cause of death was cardiovascular disease. CONCLUSION: Treatment Of acutely sick, frail, older patients in a GEMU substantially reduced mortality.