Short-term Effects of an Inpatient Geriatric Consultation Team on Geriatric Syndrome Patients

A Pilot Study of the Short-term Effects of an Inpatient Geriatric Consultation Team on Geriatric Syndrome Patients

Patients admitted to acute ordinary wards in a medical center in Southern Taiwan from an elder-integrated outpatient department or emergency room from January 2017 to December 2017 were included if they met the following criteria: (i) age 65 years or older, (ii) Barthel index score ≦60 and (iii) with at least one of the following geriatric syndromes: unsteady gait or easy-to-fall ( falls ≧ 2 in last 1 year), malnutrition with Mini Nutritional Assessment-Short Form screening score < 12, urinary incontinence, pressure sores, dementia, delirium, depression, polypharmacy (≧8 medications), and excessive utilization of healthcare facilities (admission≧2, visit Emergency≧2, or visit outpatient department≧12 in one month). Patients were excluded if they were in a vegetative state, under palliative care or terminally ill and suffering from acute illness needing to be transferred to or cared for in the Intensive Care Unit.

Human participant approval was obtained from the Chang Gung Medical Foundation Institutional Review Board before data collection. Participants were recruited from the ordinary wards by research assistants who screened the admission list every morning if they met the inclusion criteria. Then, the detail of the research was explained to the patients and families. They were allowed to choose to be in the control group or the intervention group. After the participants and or family agreed, informed consent was signed. For those who were cognitively impaired or suffered from dementia, informed consent was signed by their relative or partner. For the intervention group, a geriatric physician was consulted and recommendations were made by the geriatric consultant after a complete geriatric assessment. Besides the geriatric physician, the investigator's multidisciplinary team included a social worker, nutritionist and physical therapist. In the control group, the participants only received routine hospital care and no geriatric physician was consulted.

Study Overview

• Status: Completed
• Conditions: Depression; Senile Dementia
• Intervention / Treatment: Other: inpatient geriatric consultation team

Detailed Description

Participants were recruited from the ordinary wards by research assistants who screened the admission list every morning if they met the inclusion criteria. Then, the detail of the research was explained to the patients and families. They were allowed to choose to be in the control group or the intervention group. After the participants and or family agreed, informed consent was signed. For those who were cognitively impaired or suffered from dementia, informed consent was signed by their relative or partner. For the intervention group, a geriatric physician was consulted and recommendations were made by the geriatric consultant after a complete CGA. The CGA includes the assessment of depression, dementia, physical performance of Activity of Daily Living (ADL) and nutrition using Geriatric Depression Scale (GDC-15), Mini-Mental State Examination (MMSE), Barthel Index (BI), and Mini Nutritional Assessment-Short Form (MNA®-SF) respectively. Besides the geriatric physician, our multidisciplinary team included a social worker, nutritionist and physical therapist. In the control group, the participants only received routine hospital care and no geriatric physician was consulted. The case manager nurse filed the participant's baseline data and clinical problems. After discharge, the participant's condition was assessed via telephone in the first, third and six months after discharge.

• Study Type: Interventional
• Enrollment (Actual): 59
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

(i) age 65 years or older, (ii) Barthel index (BI) [18] score ≦60 and (iii) with at least one of the following geriatric syndromes: unsteady gait or easy-to-fall ( falls ≧ 2 in last 1 year), malnutrition with Mini Nutritional Assessment-Short Form (MNA®-SF) screening score < 12, urinary incontinence, pressure sores, dementia, delirium, depression, polypharmacy (≧8 medications), and excessive utilization of healthcare facilities (admission≧2, visit Emergency≧2, or visit outpatient department≧12 in one month)-

Exclusion Criteria:

Patients were excluded if they were in a vegetative state, under palliative care or terminally ill and suffering from acute illness needing to be transferred to or cared for in the Intensive Care Unit.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: usual care; For the intervention group, a geriatric physician was consulted and recommendations were made by the geriatric consultant and inpatient geriatric consultation team after a complete geriatric assessment (CGA). The CGA includes the assessment of depression, dementia, physical performance of Activity of Daily Living (ADL) and nutrition using Geriatric Depression Scale (GDC-15), Mini-Mental State Examination (MMSE), Barthel Index (BI), and Mini Nutritional Assessment-Short Form (MNA®-SF) respectively. Besides the geriatric physician, our multidisciplinary team included a social worker, nutritionist and physical therapist. In the control group, the participants only received routine hospital care and no geriatric physician was consulted.

Other: inpatient geriatric consultation team; For the intervention group, a geriatric physician was consulted and recommendations were made by the geriatric consultant after a complete CGA.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
readmission rate	compare the differences of readmission rates between the intervention and control groups	readmission rate within one month after discharge
readmission rate	compare the differences of readmission rates between the intervention and control groups	readmission rate within three months after discharge
readmission rate	compare the differences of readmission rates between the intervention and control groups	readmission rate within six months after discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
mortality rate	compare the differences of mortality rates between the intervention and control groups	mortality rate within one month after discharge
mortality rate	compare the differences of mortality rates between the intervention and control groups	mortality rate within three months after discharge
mortality rate	compare the differences of mortality rates between the intervention and control groups	mortality rate within six months after discharge

Collaborators and Investigators

• Sponsor: Chang Gung Memorial Hospital
• Investigators: Study Director: Song-Seng Loke

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2017
• Primary Completion (Actual): December 31, 2017
• Study Completion (Actual): December 31, 2017

Study Registration Dates

• First Submitted: January 30, 2019
• First Submitted That Met QC Criteria: February 13, 2019
• First Posted (Actual): February 15, 2019

Study Record Updates

• Last Update Posted (Actual): February 15, 2019
• Last Update Submitted That Met QC Criteria: February 13, 2019
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Neurodegenerative Diseases; Dementia; Tauopathies; Alzheimer Disease
• Other Study ID Numbers: CMRPG8F1571

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No