Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion.

DESIGN: Randomized, controlled, assessor-blinded, single-center trial.

SETTING: A geriatric ambulatory unit in a municipality in the southeast of Sweden.

PARTICIPANTS: Community-dwelling individuals aged ≥ 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG).

INTERVENTION: Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care.

OUTCOME MEASURES: Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months.

RESULTS: Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P = .026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P = .01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P = .43).

CONCLUSIONS: CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGA's superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs.

Details

Authors
  • Anne W Ekdahl
  • Jenny Alwin
  • Jeanette Eckerblad
  • Magnus Husberg
  • Tiny Jaarsma
  • Amelie Lindh Mazya
  • Anna Milberg
  • Barbro Krevers
  • Mitra Unosson
  • Rolf Wiklund
  • Per Carlsson
External organisations
  • Helsingborg Hospital
  • Karolinska Institutet
Research areas and keywords

Keywords

  • Aged, Aged, 80 and over, Ambulatory Care, Costs and Cost Analysis, Female, Frail Elderly, Geriatric Assessment, Humans, Male, Outcome Assessment (Health Care), Single-Blind Method, Sweden, Randomized Controlled Trial
Original languageEnglish
Pages (from-to)263-8
Number of pages6
JournalJournal of the American Medical Directors Association
Volume17
Issue number3
Publication statusPublished - 2016 Mar 1
Publication categoryResearch
Peer-reviewedYes
Externally publishedYes