Multidimensional geriatric assessment is a functional, psychosocial and medical evaluation of an elderly patient. Such an approach improves function and survival in frail older patients, mostly in an outpatient setting. New RCTs suggest that the application of a multidisciplinary approach to the elderly should be applied to all the patients admitted to acute care hospitals. A model of integrated geriatric care is proposed, starting in the emergency room (ER) in an acute care hospital. The project will be developed over a 3 year period. A nurse case manager will work in the ER, evaluating all the patients aged over 75. She will provide the ER physician with information on functional and psychosocial status of the patient using standardized tests, and will contact primary care physician and the social workers to gather further information. In case of hospitalization, the case manager will evaluate possible occurring complications during the hospital stay and the outcome. Given the huge amount of hospitalizations among the geriatric patients, it is mandatory that the physicians are familiar with the fundaments of geriatric culture and principles of geriatric assessment and management. This issue will be addressed through a formative plan designed for physicians and nurses. End point of the pilot study is to reduce complications of hospitalization, improve patients function at hospital discharge, decrease nursing home admissions, reduce hospital inappropriate admissions and readmissions, reduce the mean length of hospital stay and health care system costs.
Project supported by grant RF-2009-1511459 Ministero della Salute assigned to Dr Alessandra Colantoni