Comprehensive Geriatric Assessment and Transitional Care in Acutely Hospitalized Patients

Unfortunately, after elderly patients leave the hospital from an acute hospitalization, most lose the ability to complete some daily living activities, some are readmitted to the hospital, and some die, all within six months. A comprehensive geriatric assessment is completed while the patient is admitted, setting up interventions and taking care of the patient until they are discharged. Transitional care can also be completed when the patient is moving back home after this hospitalization. This care is provided for a limited amount of time, during which nurses attempt to limit the number of adverse drug events, remind patients of discharge information, and follow up with the doctors. A study was completed to measure the effectiveness of patients receiving both comprehensive geriatric assessment services as well as a transitional care program.

Three hospitals from the Netherlands participated in a double-blind randomized clinical trial between September 1, 2010 and March 1, 2014 involving 674 patients 65 or older that were acutely hospitalized for 48 hours or more in the internal medicine department and were at risk for further decline in health. The participants that consented to participating were randomly placed into a group receiving both interventions or purely comprehensive geriatric assessments. Patients receiving transitional care had a nurse visit about four days after they were admitted to the hospital, then two days after discharge and two weeks, six weeks, twelve weeks, and twenty-four weeks after discharge to monitor the patients’ conditions and initiate or follow through with interventions.

It was found that there was no difference in the ability to complete daily living activities between those receiving both treatments and those just receiving comprehensive geriatric assessments. There was a statistical difference however in the ability to complete daily activities between those who died after their acute hospitalization and those who survived for at least six months. 85 participants died among those receiving both treatments and 104 died among those receiving only comprehensive geriatric assessments. There were 106 readmissions among those receiving both interventions and 88 among those receiving only comprehensive geriatric assessments but no time difference was noticed. It was concluded that although there was a lower mortality rate within 1 month and 6 months of discharge in the group receiving both interventions, there was no difference in effect on ability to complete daily living tasks.

Even if this addition of therapy may cause a slight extension of life, is it worth the extra time and cost of nurses to continue providing transitional care when there is no benefit on the patient’s ability to complete everyday tasks?

Reference: Buurman BM, Parlevliet JL, Allore HG, et al. Comprehensive geriatric assessment and transitional care in acutely hospitalized patients: the transitional care bridge randomized clinical trial. Jama Intern Med. Published online February 15, 2016.