Long-term evaluation of the ambulatory geriatric assessment-a frailty intervention trial (AGE-FIT)-clinical outcomes and total costs after 36 months

Objective: To compare mortality and costs of health and social care between participants with access to care based on Comprehensive Geriatric Assessment (CGA) in an out-patient care setting with a control group receiving usual care only. The comparison was done 36 months after inclusion. Methods: Randomized controlled trial. Inclusion criteria: community-dwelling, aged ≥75 years, ≥3 hospitalisations the last year and ≥3 medical diagnoses. Mean age 82.5 years. Results: A total of 208 participants in the intervention group (IG) and 174 in the control group (CG). Participants in the IG lived longer than the participants in the CG. 27.9% (n = 58) in the IG versus 38.5% (n = 67) in the CG had died. HR= 1.49; CI; 1.05-2.12; P = 0.026. Mean number of inpatient days was lower in the IG (intervention 15.1 (SD 18.4), control 21.0 (SD 25.0), P = 0.01. No differences in the overall costs between the IG and CG including costs for home-help service and nursing home. Mean cost during the 36-month period after baseline assessment expressed as USD/patient (SD) in the IG was 71905 (85560) versus 65626 (66338) in the CG: P = 0.43. Conclusion: Better survival and fewer days in hospital three years after baseline assessment without increasing costs. This strengthens the positive results of a care based on CGA not only in acute care settings but also in outpatient care. A change of to-days health care organization focused on a one organ/disease is needed to a more comprehensive and preventive care of the oldest old.