Geriatric principles: evidence-based medicine at its best.

摘要

Much of geriatric care involves doing the obvious and involves "high-touch" care with a skilled interprofessional team. Despite this, the Cochrane collaboration meta-analysis showed that comprehensive geriatric assessment reduced institutionalization and death or deterioration and improved cognition. Outcomes were best when carried out in an inpatient environment that is often equivalent to a specialized skilled nursing facility. Subsequently, a comprehensive geriatric assessment for frail patients with heart failure showed a decrease in hospitalization and a cost savings for frail and prefrail patients. Delirium intensive care units have been shown to reduce length of stay in hospitals and improve outcomes for persons with delirium. A simple volunteer-run preventive program limited the rate of functional deterioration. Nursing homes with medical directors who have received training in geriatric principles have better outcomes than those who have not had training. The Journal has characterized the difficulty and expense of obtaining high-quality outcomes in patients with hip fracture. In this issue, Singh et al present a remarkable study in which the addition of a comprehensive geriatric assessment and resistance training markedly improved outcomes for patients with hip fracture.