A Clinimetric Evaluation of Specialized Geriatric Care for Rural Dwelling, Frail Older People

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Abstract
OBJECTIVE: To test Comprehensive Geriatric Assessment (CGA) as an adjunct to usual care.DESIGN: A randomized controlled trial with 3, 6, and 12 months follow‐up.SETTING: Rural communities.PATIENTS: A total of 182 of 265 frail older patients (52 refused, 2 withdrawn, 27 ineligible, 2 deaths) referred by family practitioners with allocation to intervention (n = 95) or usual care (n = 87).INTERVENTION: Three‐month implementation of CGA recommendations by a Mobile Geriatric Assessment Team (MGAT) with follow‐up assessments at 3, 6, and 12 months. Geriatric nurse assessors, blinded to group assignment, performed each assessment.MAIN OUTCOME MEASURE: Goal Attainment Scaling (GAS).RESULTS: Baseline characteristics were comparable between groups. At 3 months, the intervention group was more likely to attain their goals (GAS total: X̄ = 46.4 ± 5.9; GAS outcome X̄ = 48.0 ± 6.6) compared with controls (total: X̄ = 38.7 ± 4.1; outcome X̄ = 40.8 ± 5.6) (P < .001). Standard assessments of function (Barthel index, instrumental activities of daily living), cognition (Mini‐Mental State Examination), and quality of life (modified Spitzer quality of life index) showed no difference over 12 months. No difference in survival (intervention: X̄ = 320 days, SE = 6; control: X̄ = 294 days, SE = 6; P = .257) or time to institutionalization (intervention: 340 days, SE = 9; control: 342 days, SE = 8; log rank = 0.661; P = .416) were observed.CONCLUSIONS: A MGAT can target rural dwelling, frail older persons, perform in‐home CGA, and develop an intervention strategy. Although the intervention did not prolong life or delay institutionalization, clinically important benefits were observed.