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. 1986 Feb;20(6 Pt 2):881–895.

Differential prognosis and utilization patterns among clinical subgroups of hospitalized geriatric patients.

L Z Rubenstein, K R Josephson, G D Wieland, R L Kane
PMCID: PMC1068912  PMID: 3512487

Abstract

While screening elderly inpatients on acute Veterans Administration (VA) hospital wards for a special geriatric program, we prospectively classified all patients age 65 and over, who had been hospitalized at least a week, into five clinical subgroups using specific diagnostic, prognostic, and functional criteria. These five subgroups were "geriatric evaluation unit (GEU) candidate", "severely demented", "medical", "terminal", and "independent". Medical record data from the initial admission and a full year of follow-up were collected from random samples of each subgroup and of nonscreened patients who had been hospitalized for less than a week. Analysis revealed that each subgroup had a distinctive pattern of survival, living location, and use of institutional services during the follow-up period. For one major subgroup ("GEU candidate"), a specific intervention (the GEU) has proved very effective in reducing mortality, increasing patient functioning, improving placement, and decreasing use of institutional services. Moreover, there are specific treatment and intervention strategies appropriate for each of the other subgroups (e.g., hospital-based home care, hospice, respite, and day treatment programs), although these services are not universally available nor clearly proved effective. The process of identifying patient subgroups illustrated in this study may be useful in needs assessment, in planning new intervention programs for frail elderly patients, and for identifying appropriate patients for these programs.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Birnbaum H. G., Kidder D. What does hospice cost? Am J Public Health. 1984 Jul;74(7):689–697. doi: 10.2105/ajph.74.7.689. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Davis J. W., Shapiro M. F., Kane R. L. Level of care and complications among geriatric patients discharged from the medical service of a teaching hospital. J Am Geriatr Soc. 1984 Jun;32(6):427–430. doi: 10.1111/j.1532-5415.1984.tb02217.x. [DOI] [PubMed] [Google Scholar]
  3. Glass R. I., Mulvihill M. N., Smith H., Jr, Peto R., Bucheister D., Stoll B. J. The 4 score: an index for predicting a patient's non-medical hospital days. Am J Public Health. 1977 Aug;67(8):751–755. doi: 10.2105/ajph.67.8.751. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hughes S. L., Cordray D. S., Spiker V. A. Evaluation of a long-term home care program. Med Care. 1984 May;22(5):460–475. doi: 10.1097/00005650-198405000-00010. [DOI] [PubMed] [Google Scholar]
  5. Inui T. S., Stevenson K. M., Plorde D., Murphy I. Identifying hospital patients who need early discharge planning for special dispositions: a comparison of alternative techniques. Med Care. 1981 Sep;19(9):922–929. doi: 10.1097/00005650-198109000-00004. [DOI] [PubMed] [Google Scholar]
  6. Kane R. L., Matthias R. From hospital to nursing home: the long-term care connection. Gerontologist. 1984 Dec;24(6):604–609. doi: 10.1093/geront/24.6.604. [DOI] [PubMed] [Google Scholar]
  7. Kane R. L., Matthias R., Sampson S. The risk of placement in a nursing home after acute hospitalization. Med Care. 1983 Nov;21(11):1055–1061. doi: 10.1097/00005650-198311000-00002. [DOI] [PubMed] [Google Scholar]
  8. Lamont C. T., Sampson S., Matthias R., Kane R. The outcome of hospitalization for acute illness in the elderly. J Am Geriatr Soc. 1983 May;31(5):282–288. doi: 10.1111/j.1532-5415.1983.tb04872.x. [DOI] [PubMed] [Google Scholar]
  9. Rubenstein L. Z., Abrass I. B., Kane R. L. Improved care for patients on a new geriatric evaluation unit. J Am Geriatr Soc. 1981 Nov;29(11):531–536. doi: 10.1111/j.1532-5415.1981.tb03357.x. [DOI] [PubMed] [Google Scholar]
  10. Rubenstein L. Z., Josephson K. R., Wieland G. D., English P. A., Sayre J. A., Kane R. L. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med. 1984 Dec 27;311(26):1664–1670. doi: 10.1056/NEJM198412273112604. [DOI] [PubMed] [Google Scholar]
  11. Rubenstein L. Z., Rhee L., Kane R. L. The role of geriatric assessment units in caring for the elderly: an analytic review. J Gerontol. 1982 Sep;37(5):513–521. doi: 10.1093/geronj/37.5.513. [DOI] [PubMed] [Google Scholar]
  12. Rubenstein L. Z., Wieland D., English P., Josephson K., Sayre J. A., Abrass I. B. The Sepulveda VA Geriatric Evaluation Unit: data on four-year outcomes and predictors of improved patient outcomes. J Am Geriatr Soc. 1984 Jul;32(7):503–512. doi: 10.1111/j.1532-5415.1984.tb02235.x. [DOI] [PubMed] [Google Scholar]

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