Positive effects on activities of daily living one year after receiving comprehensive geriatric assessment - results from the randomised controlled study CGA-Swed

Katarina Wilhelmson; Isabelle Andersson Hammar; Theresa Westgård; Lena Holmquist Henrikson; Synneve Dahlin-Ivanoff

doi:10.1186/s12877-022-02862-6

Positive effects on activities of daily living one year after receiving comprehensive geriatric assessment - results from the randomised controlled study CGA-Swed

BMC Geriatr. 2022 Mar 3;22(1):180. doi: 10.1186/s12877-022-02862-6.

Authors

Katarina Wilhelmson^{1

2

3

4}, Isabelle Andersson Hammar^{5

6}, Theresa Westgård^{5

6}, Lena Holmquist Henrikson^{7

8}, Synneve Dahlin-Ivanoff^{6

9}

Affiliations

¹ Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden. katarina.wilhelmson@gu.se.
² Centre of Aging and Health-AGECAP, University of Gothenburg, Gothenburg, Sweden. katarina.wilhelmson@gu.se.
³ Department of Acute Medicine and Geriatrics, The Sahlgrenska University Hospital, Region Västra Götaland, 413 45, Gothenburg, Sweden. katarina.wilhelmson@gu.se.
⁴ The Geriatric Development Centre, The Sahlgrenska University Hospital, Region Västra Götaland, 413 45, Gothenburg, Sweden. katarina.wilhelmson@gu.se.
⁵ Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
⁶ Centre of Aging and Health-AGECAP, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Acute Medicine and Geriatrics, The Sahlgrenska University Hospital, Region Västra Götaland, 413 45, Gothenburg, Sweden.
⁸ The Geriatric Development Centre, The Sahlgrenska University Hospital, Region Västra Götaland, 413 45, Gothenburg, Sweden.
⁹ Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Abstract

Background: Today's acute hospital care is poorly adapted to the complex needs of frail older people. This exposes them to avoidable risks, such as loss of functional capacities, leading to unnecessary health and social care needs. Being frail and in need of acute hospital care often leads to higher dependence in Activities of Daily Living (ADL), especially if one's needs are not acknowledged. Comprehensive Geriatric Assessment (CGA) is one way to meet frail older people's complex needs. The study's aim was to investigate the effects on frail older people's ADL 12 months after receiving CGA.

Methods: This is a two-armed randomised controlled intervention study. Participants were frail older people (75+) who sought the emergency department and needed admission to a medical ward. The intervention was CGA performed at a geriatric management unit during the hospital stay. The CGA included comprehensive assessment of medical, functional, psychological, social, and environmental status as well as treatment, rehabilitation, discharge planning, and follow-up. Multidisciplinary teamwork and a person-centred approach were used. The control was care at an ordinary medical hospital ward. The primary outcome was change in dependence in ADL from 2 weeks before admission to the 12-month follow-up.

Results: At admission, 155 people participated (77 in the control, 78 in the intervention). At the 12-month follow-up, 78 participated (40 in the control, 38 in the intervention). Attrition was mainly due to mortality. Four participants in the control (5.2%) and twelve in the intervention group (15.4%) had improved in their ADL 1 year after discharge (OR = 3.32; 95% CI = 1.02-10.79).

Conclusions: In-hospital CGA performed at a geriatric management unit improves frail older people's ADL. Being less dependent in ADL increases frail older people's ability to remain in their own housing, which is important for both the individual and society.

Trial registration: ClinicalTrials.gov, NCT02773914 . Retrospectively registered 16 May 2016.

Keywords: Activities of daily living; Comprehensive geriatric assessment; Frailty; Hospital care; Intervention.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living*
Aged
Emergency Service, Hospital
Frail Elderly
Geriatric Assessment*
Hospitalization
Humans
Length of Stay

Associated data

ClinicalTrials.gov/NCT02773914