Therapy: Alternative Clinical Scenario
You are responsible for a geriatric assessment program in your region that involves having people ≥ 75 years of age who live at home, seen by a multidisciplinary geriatric team. You are asked by a relative to see an 80 year old woman who lives by herself in the community and who has refused (on several occasions) to visit her GP. She has some difficulty with ambulating since she had a stroke 5 years previously. Her family is concerned because she has noted a decrease in visual acuity and hearing and they have noticed that her memory has declined. When you visit her, you find she is a very pleasant, independent woman who wants to know why you are there and how you can help her. You explain that you want to assess her physical and functional status and social situation because your aim is to help people maintain their independence in the community. She says "Prove it to me".
You formulate the question, "In an elderly patient who lives at home, does a comprehensive geriatric assessment decrease the risk of nursing home admission and improve functional status?" Fortunately, you have brought your notebook computer with you which has the latest version of Best Evidence on it. You search Best Evidence using the term "geriatric assessment" and find an abstract and commentary on an article by Stuck et al which looks promising. ( NEJM 1995;333:1184-9 ). You tell the patient that you will obtain this article from your office and will return to her with the evidence.
Read the article and decide:
- Is the evidence from this randomised trial valid?
- If valid, is this evidence important?
- If valid and important, can you apply this evidence in caring for your patient?