In the proposed three and a half year clinical trial of 400 frail older adults, we will (1) compare a set of randomly assigned elderly patients who have been evaluated by one of four outpatient geriatric assessment units with a group diagnosed by community physicians (CMD) to determine how the two groups differ in terms of the identification of health problems, in particular the identification of cognitive impairment, depression and polypharmacy, (2) compare/contrast during the year following the initial diagnosis, the physical, mental, and social health status, health service utilization costs, and patient and caregiver satisfaction of the two groups. Patients (or surrogates) will be interviewed in person at 4 month intervals over a 12 month span and by telephone each month following the intervention. Caregivers will be interviewed by telephone at 4 month intervals. Patient chart data will be abstracted 6 months into the study. The third and fourth aims of the study are (3) to identify which sub groups of the frail elderly can best be served by an outpatient geriatric assessment unit (GAU) in order to develop guidelines for referral to GAU's, and (4) to observe and qualitatively describe the structure and process of geriatric assessment in the four participating GAUs with the aim of contributing to an understanding of what makes this technology effective in patients with a favorable outcome.
| Adams, J; Silverman, M; Musa, D et al. (1997) Recruiting older adults for clinical trials. Control Clin Trials 18:14-26 |
| Silverman, M; McDowell, B J; Musa, D et al. (1997) To treat or not to treat: issues in decisions not to treat older persons with cognitive impairment, depression, and incontinence. J Am Geriatr Soc 45:1094-101 |
| Silverman, M; Musa, D; Martin, D C et al. (1995) Evaluation of outpatient geriatric assessment: a randomized multi-site trial. J Am Geriatr Soc 43:733-40 |
| McDowell, B J; Silverman, M; Martin, D et al. (1994) Identification and intervention for urinary incontinence by community physicians and geriatric assessment teams. J Am Geriatr Soc 42:501-5 |
