Geriatric Inpatient Units in the Care of Hospitalized Frail Adults with a History of Heart Failure

SummaryBackgroundFrail hospitalized older adults are at risk for adverse outcomes. Previous studies have suggested benefits for inpatient geriatric management (GEM). We sought to determine whether hospitalized patients with a history of heart failure (HF) benefitted from inpatient GEM or not.MethodsWe studied 309 inpatients previously diagnosed with HF who were participants in a randomized trial of geriatric evaluation and management (GEM) versus usual care (UC). The intervention involved multidisciplinary teams that provided comprehensive geriatric assessment. We evaluated health-related quality of life (HRQOL), basic activities of daily living (ADLs), health service utilization, and survival at discharge, 6 months, and 1 year post randomization.ResultsGEM patients had higher mean change scores for physical function (unadjusted means: 0.17 vs. –4.67, p = 0.046) and basic ADLs (1.25 vs. 0.67, p = 0.003) at hospital discharge, which remained significant after adjusting for baseline HRQOL scores and in-hospital days. Outcomes were not significantly different at 1 year. Length of stay for GEM was greater than UC (24 days vs. 17 days, p = 0.03), but total costs at 1 year were not different (p = 0.9). Mortality rates at 1 year were high and similar (GEM 29.0%, UC 27.3%, p = 0.73) in both the groups.ConclusionInpatient GEM was associated with better maintenance of physical function and basic ADLs at hospital discharge; however, no differences in HRQOL or survival were observed between GEM and UC at 1 year post randomization. Restructuring inpatient care models to incorporate inpatient GEM principles may be one method to optimize health-care delivery.