58GERIATRICIAN-PERFORMED COMPREHENSIVE GERIATRIC CARE IN OLDER ADULTS REFERRED TO AN OUTPATIENT COMMUNITY REHABILITATION UNIT: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: A continuous reduction in hospital length of stay worldwide means that most rehabilitation for frail older adults following acute hospital care will take place in an outpatient community setting in the future. We investigated the effect of geriatricianperformed comprehensive geriatric care (CGC) in older adults referred to a non-hospital based community rehabilitation unit. Design(s): Randomized controlled trial. Setting(s): Two Danish outpatient rehabilitation units. Participant(s): Persons aged 65 or older admitted from home or hospital. Intervention(s): CGC performed by a geriatrician in collaboration with the staff of the rehabilitation units. The intervention focused on medication adjustment with particular attention to drugs which may lead to cognitive impairment, falls, or malnutrition. Outcome(s): Primary outcome was number of inpatient contacts (hospital admissions and ED-visits). Secondary outcomes were medication burden, cognitive functioning measured by Mini-Mental Status Examination (MMSE), activities of daily living measured by Modified Barthel-100 Index (MBI) and overall quality of life measured by Depression List (DL). Outcomes were measured within 90 days of admission to the rehabilitation units. Result(s): 368 persons were randomized: 185 to the intervention group (IG) vs 183 to the control group (CG). Groups were comparable at baseline. The number of inpatient contacts did not differ between the groups. Fewer participants in the IG had hyperpolypharmacy (P = .01), or used hypnotics and sedatives (P = .02), furosemide (P < .001) or quinin (P = .02), while more participants used tricyclic antidepressants (P = .01) in the IG compared to CG at 90-day follow-up. More participants in IG discontinued (P < .001), or reduced drugs dosage (P < .001) compared to CG at 90-day follow-up. There were no differences between the groups with regard to number of drugs, or in the means of MMSE, MBI or DL sum-scores, but more participants in the IG improved their OQoL (OR 1.63, 95% CI: 1.07-2.48, P = .023). Conclusion(s): Geriatrician-performed CGC in older adults in an outpatient community rehabilitation unit had no effect on number of inpatient contacts, cognitive functioning or activities of daily living, but may reduce medication burden and improve overall quality of life during the 90-day follow-up period.