Older Patients in the Acute Setting - Is There a Better Solution?

Background A substantial amount of older (>65 years) patients admitted to the Acute Medical Unit (AMU) at Bispebjerg Hospital are often characterized by complex health related and medication problems, functional loss and atypical presentation of symptoms. We established a Geriatric Acute Team (GATE) with the aim to investigate whether these older patients could benefit of an acute geriatric assessment. Methods All patients > 65 years admitted to the AMU were screened every morning between March and June 2016. Exclusion criteria were medical unstable conditions and need for specialized medical treatment. The control group received treatment after usual standard at the AMU, whereas, the case group received an acute geriatric assessment and follow-up in GATE conducted by a senior consultant in geriatric medicine. Data were retrieved from the patient’s medical journals and included demographic and medical related variables. Results We included 183 patients as controls and 150 as cases. Seventy-two (72) and 96 of control and case patients, respectively accepted participation in the study. We enrolled 3.7 patients in GATE daily. At enrollment, average age was 81 years (65-101), 71 % took >5 pharmaceuticals and 58 % had more than 3 simultaneous present diseases. Implementing GATE resulted in shorter hospitalization times at AMU (p=0.03), fewer doctors attending the single patient (p=0.02), fewer 30-day readmission (p=0.05) and more patients being transferred to the geriatric ward (p=0.002). Conclusion Elderly frail acutely admitted patients, not in need of specialized medical treatment, benefitted from early geriatric assessment at the AMU.