Year: 1984
Type: letter
Abstract: To the Editor:—Because of the paucity of data from controlled trials on geriatric assessment units, the study by Teasdale et al.1 in the September 1983 issue will undoubtedly be cited frequently. However, the study population, which was selected on the basis of an age 75 years or more and the presence of a “medical illness requiring hospitalization,” is unique among studies of geriatric assessment units.2 The subjects of most studies of these units have been selected by functional status, mental status, availability of social supports, and consideration of nursing home admission, all of which greatly influence the placement of an elderly patient in a nursing home.2 Data on these factors are not given in the Teasdale study, and one wonders whether the two groups in the study are comparable according to these criteria. Furthermore, patient characteristics are inadequately described, leaving unanswered the question of to what type of patients these results pertain. Related to the issue of subject selection is the authors' statement that an equal number of patients in each group carried diagnoses of one or more of ten diseases, the treatment of which the authors felt might derive benefit from a geriatric assessment unit. These diagnoses were: neoplasms, diabetes, dementia, Parkinson's disease, visual or auditory loss, cardiovascular disease, cerebrovascular disease, amputations, and fecal or urinary incontinence. However, we are not told about the degree of disability of these patients nor are we told about the number or percentage of patients in each group with each of these geriatric diagnoses. Did the patients with these diagnoses in each study group have a comparable degree of disability? Do these diagnoses comprise the dominant diagnoses within the study populations or, although equally distributed between the two groups, are these diagnoses unrepresentative of the diagnoses in the study groups? Rather than viewing geriatrics as an area of health care characterized by chronological age and the presence or absence of an acute illness, geriatricians have emphasized features such as the altered physiology of advanced age, the presence of multiple chronic diseases, functional impairments, and the tendency for nonspecific and atypical presentations of illness. Since the study population of this unit was not selected by any combination of these features, I am not surprised that the geriatric assessment unit was not efficacious in influencing placement. Perhaps a study that selects patients based on acute medical criteria should select more appropriate outcomes than nursing home placement to show the benefits of a geriatric assessment unit. These might include: 1) number and type of new diagnoses, 2) number and type of medications used during the hospitalization and at discharge, 3) iatrogenic complications of disease, and 4) incidences of decubiti, episodes of falling, and urinary incontinence developing after admission.
Author: Jerry C. Johnson
Institutions: Philadelphia VA Medical Center, University of Pennsylvania
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4242821550