Outpatient comprehensive geriatric assessment: effects on frailty and mortality in old people with multimorbidity and high health care utilization

摘要

BackgroundMultimorbidity and frailty are often associated and Comprehensive Geriatric Assessment (CGA) is considered the gold standard of care for these patients.AimsThis study aimed to evaluate the effect of outpatient Comprehensive Geriatric Assessment (CGA) on frailty in community-dwelling older people with multimorbidity and high health care utilization.MethodsThe Ambulatory Geriatric AssessmentFrailty Intervention Trial (AGe-FIT) was a randomized controlled trial (intervention group, n=208, control group n=174) with a follow-up period of 24months. Frailty was a secondary outcome. Inclusion criteria were: age75 years, 3 current diagnoses per ICD-10, and 3 inpatient admissions during 12months prior to study inclusion. The intervention group received CGA-based care and tailored interventions by a multidisciplinary team in an Ambulatory Geriatric Unit, in addition to usual care. The control group received usual care. Frailty was measured with the Cardiovascular Health Study (CHS) criteria. At 24 months, frail and deceased participants were combined in the analysis.ResultsNinety percent of the population were frail or pre-frail at baseline. After 24 months, there was a significant smaller proportion of frail and deceased (p=0.002) and a significant higher proportion of pre-frail patients in the intervention group (p=0.004). Mortality was high, 18% in the intervention group and 26% in the control group.ConclusionOutpatient CGA may delay the progression of frailty and may contribute to the improvement of frail patients in older persons with multimorbidity.