Volume 39, Issue S1 p. 8S-16S

Impacts of Geriatric Evaluation and Management Programs on Defined Outcomes: Overview of the Evidence

Dr. Laurence Z. Rubenstein MD, MPH

Corresponding Author

Dr. Laurence Z. Rubenstein MD, MPH

Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Sepulveda, California

University of California, School of Medicine, Los Angeles, California.

GRECC (11E), Sepulveda VA Medical Center, 16111 Plummer Street, Sepulveda CA 91343.Search for more papers by this author
Andreas E. Stuck MD

Andreas E. Stuck MD

University of California, School of Medicine, Los Angeles, California.

Dr. Stuck is a recipient of a grant from the Swiss National Foundation for Scientific Research.

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Albert L. Siu MD, MSPH

Albert L. Siu MD, MSPH

Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Sepulveda, California

Dr. Siu is supported by an Academic Award from the NIA.

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Darryl Wieland PhD, MPH

Darryl Wieland PhD, MPH

Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Sepulveda, California

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First published: September 1991
Citations: 389

Earlier draft developed and presented at a Geriatric Evaluation and Management Conference in Washington, DC, September 1989, sponsored by the Department of Veterans Affairs Health Services Research and Development Service, National Institute on Aging, and Robert Wood Johnson Foundation. Part of this paper was based on a previous paper by the authors published in Aging: Clinical and Experimental Research (I:87–98, 1989).

Abstract

Comprehensive geriatric assessment is a technique for multidimensional diagnosis of frail elderly people with the purpose of planning and/or delivering medical, psychosocial, and rehabilitative care. When comprehensive geriatric assessment is coupled with some therapy, then the term geriatric evaluation and management (GEM) will be used. Following a brief history of comprehensive geriatric assessment, we describe the varied patterns of GEM program organization and review the literature of studies examining GEM effectiveness. Program diversity complicates drawing firm conclusions about GEM effects; however, the vast majority of studies report positive, if not uniformly significant, results. Our analysis suggests that much of the variability in findings is due to sample size limitations

In order to reach conclusions of program effects across studies and to avoid problems of small sample sizes, we undertook a formal meta-analysis. In this initial meta-analysis, we sought to evaluate the effect of GEM programs on a single outcome: mortality. We pooled all published GEM controlled trials into four major groups: inpatient consultation services, inpatient GEM units, home assessment services, and outpatient GEM programs. Meta-analysis of 6-month mortality demonstrates a 39% reduction of mortality for inpatient consultation services (odds ratio 0.61, 95% confidence interval 0.46–0.81, P = 0.0008) and a 37% reduction of mortality for inpatient GEM units (odds ratio 0.63, 95% CI 0.42–0.93, P = 0.02). Home assessment services reduced mortality by 29% (odds ratio 0.71, 95% CI 0.55–0.90, P = 0.005). On the other hand, no significant survival effect was found for outpatient GEM programs (odds ratio 0.96, 95% confidence interval 0.61–1.49). Further use of meta-analytic techniques should be employed to clarify the effect of GEM on other important outcomes (eg, functional status, use of hospitals and nursing homes) as well as to identify program characteristics most effective in achieving these benefits.