Comprehensive geriatric assessment for older adults admitted to ...

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White 1994 Methods Year: 1994 Location: Nashville, Tennessee, USA (University Hospital) Team/ward?: ward Timing: stepdown from acute wards Trial methodology: randomised controlled trial Participants Numbers (total): 40 Mean age: 76.5 Male:female ratio: 37% Inclusion criteria: age 65 or over, medically stable, “potential for making improvement in physical, functional or psychological function”, complicated discharge or awaiting placement. Terminal patients accepted. Exclusion criteria: not explicitly stated. Patient selection criteria: selected Patient selection criteria details: as above Interventions Team members: senior geriatrician, geriatric nurse specialist, social worker, dietician, pharmacist, physiotherapist, occupational therapist, speech and language therapist Team organisation: admission to a 6-bedded stepdown ward. Weekly multidisciplinary meetings, full comprehensive assessment, therapy and discharge planning. Review of medications and appropriate limits on investigations. Control group were reviewed by senior nurse and geriatrician and recommendations were made to usual care team. Outcomes Outcomes: death, nursing home admission, functional status, 30-day readmissions and costs Trial conclusions: CGA is cost-effective and improves patient outcomes without increasing length of stay Notes Risk of bias Bias Authors’ judgement Support for judgement Random sequence generation (selection bias) Low risk Random numbers table Allocation concealment (selection bias) Unclear risk Not described Blinding (performance bias and detection bias) All outcomes Incomplete outcome data (attrition bias) All outcomes High risk Patients experienced a change in staff and ward placement. No blinding of outcome assessment. Low risk Intention-to-treat analysis Selective reporting (reporting bias) Unclear risk No a priori documentation could be found to judge this item Comprehensive geriatric assessment for older adults admitted to hospital (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 50
White 1994 (Continued) Other bias Unclear risk Selection bias not clear with randomisation method. Attrition bias not apparent Baseline outcome measurements similar Unclear risk Baseline measurements not recorded Baseline characteristics similar Unclear risk Baseline measurements not recorded Study protected against contamination Unclear risk Differing staff delivered the intervention Winograd 1993 Methods Year: 1993 Location: Palo Alto, Ca, USA (VA Teaching Hospital) Team/ward?: team Timing: stepdown Trial methodology: randomised controlled trial Participants Numbers (total): 197 Mean age: 76 Male:female ratio: 100% male Inclusion criteria: all male patients 65 or over, expected to stay > 96 hours, within 2hour drive, not enrolled in geriatric/rehab programme, functionally impaired “frailty”: confusion, dependence in ADLs, polypharmacy, stressed caregiver system Exclusion criteria: independent, permanent nursing home resident, less than 6 months life-expectancy Patient selection criteria: selected Patient selection criteria details: proxy measures of frailty to exclude independent patients or those already dependent Interventions Team members: senior geriatrician, trainee geriatrician, specialist nurse input, social work, dietician Team organisation: comprehensive assessment, standardised assessment tools Outcomes Outcomes: death, institutionalisation, cognition, dependence Trial conclusions: no evidence of benefit from geriatric consultation team Notes Risk of bias Bias Authors’ judgement Support for judgement Random sequence generation (selection bias) Low risk Random number table with variable block permutation Allocation concealment (selection bias) Low risk Numbered sequential opaque sealed envelopes Comprehensive geriatric assessment for older adults admitted to hospital (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 51
Page 1 and 2: Comprehensive geriatric assessment
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