Effect of an Inpatient Geriatric Consultation Team on Functional Outcome, Mortality, Institutionalization, and Readmission Rate in Older Adults with Hip Fracture: A Controlled Trial
OBJECTIVES: To evaluate the effect of an inpatient geriatric consultation team (IGCT) on end points of interest in people with hip fracture: length of stay, functional status, mortality, new nursing home admission, and hospital readmission. DESIGN: Controlled trial based on assignment by convenience. SETTING: Trauma ward in a university hospital. PARTICIPANTS: One hundred seventy-one people with hip fracture aged 65 and older. INTERVENTION: Participants were assigned to a multidisciplinary geriatric intervention (n 5 94) or usual care (n 5 77) during hospitalization after hip fracture. MEASUREMENTS: End points were functional status, length of stay, mortality, new nursing home admission, and hospital readmission 6 weeks, 4 months, and 12 months after surgery. RESULTS: Mean length of stay was 11.1 5.1 days in the intervention group and 12.4 8.5 days in the control groups (P 5.24). Complete adherence to IGCT recommendations was 56.8%. A significant benefit of intervention on functional status in univariate analyses (P 5.02) 8 days after surgery disappeared in a linear mixed model. Participants with dementia had better functional status in a linear mixed model than those without (P 5.03), but this effect was no longer significant after Bonferroni correction for multiple testing. After 6 weeks, 4 months, and 12 months, no between-group differences could be documented for mortality, new nursing home admission, or readmission rate. CONCLUSION: This trial could not document functional benefits of an IGCT intervention in people with hip fracture. More research is needed to investigate whether a more-intensive approach with more-direct control over patient management, more-specific recommendations, and more-intense education would be effective.
J Am Geriatr Soc 59:1299–1308, 2011.
Key words: geriatric consultation; inpatient; elderly; hip fracture
https://lirias.kuleuven.be/bitstream/123456789/298224/2/Deschodt+et+al.+JAGS+2011.pdf
