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Centre for Evidence-
Based Medicine

Geriatric Assessment - Improves functional status and decreases nursing home admissions

Clinical Bottom Line

Geriatric assessment decreases admissions to long-term nursing homes and improves functional status.

Citation

Stuck AE, Aronow HU, Steiner A et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. NEJM 1995;333:1184-9

Clinical 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?

Search Terms

"geriatric assessment" in Best Evidence

The Study

  • Single-blinded randomised controlled trial without intention-to-treat. patients > 75 years of age who lived at home
  • Control group (N = 199; 199 analysed): usual care by their physicians
  • Experimental group (N = 215; 215 analysed): annual assessments in their homes from gerontologic nurse practitioners-assessments included medical history, physical exam, lab tests; determinations of functional and mental status, oral health, gait and balance, medications, vision, hearing, social network and support, home safety and external access

The Evidence

Outcome Time to Outcome CER EER RRR ARR NNT
long-term nursing home admission 3 years 0.101 0.042 58% 0.059 17
95% Confidence Intervals 9% to 100% 0.009 to 0.109 9 to 108
admission to acute care hospital 3 years 0.467 0.460 1% 0.007 143
95% Confidence Intervals -19% to 22% -0.089 to 0.103 NNT = 10 to INF
NNH = 11 to INF

Comments

  1. cost of intervention included in this paper but may differ according to your location
  2. these patients had higher education level, lower mortality rate and lower rate of acute care hospital admission -therefore need to compare this to your own population to assess applicability
  3. uncertain which components of the geriatric assessment are the most important and have the greatest impact on maintaining independence

Appraised By

Straus, 1998

Expiry Date

2000