Karen Stadnyk

BACKGROUND: The heterogeneity of health problems experienced by frail elderly patients makes it difficult to use a single standard measure to evaluate multiple outcomes of geriatric rehabilitation. Commonly, several measures are used, but an alternative is to use an individualized measure such as Goal Attainment Scaling (GAS). This study investigated the reliability, validity, and responsiveness of GAS as an outcome measure in geriatric rehabilitation. METHODS: We studied 173 consecutive admissions (mean age 81; 77% female; mean length of stay 33 days) to a geriatric rehabilitation unit. Assessment instruments were completed at admission and discharge. Individualized treatment goals were identified for each patient by using GAS; standardized measures included self-rated health, a global clinical assessment, the Barthel Index, the OARS IADL scale, the Folstein Mini-Mental State Examination (MMSE), and the Nottingham Health Profile (NHP). RESULTS: Mobility, future care arrangements, and functional impairment were the most commonly identified GAS goal areas. The interrater reliability of the GAS discharge score was 0.93. The GAS discharge score correlated strongly (r> or =0.50) with the standardized measures, except for self-rated health, the MMSE, and the NHP (r> or =0.31). GAS was more responsive to change than any of the standardized measures. The GAS score was used to derive receiver operating characteristic curves for other measures; this can provide insight into the interpretation of clinically important outcomes. CONCLUSIONS: GAS appears to be a feasible, reliable, valid, and responsive approach to outcome measurement in geriatric rehabilitation.

OBJECTIVE : To test Comprehensive Geriatric Assessment (CGA) as an adjunct to usual care. DESIGN : A randomized controlled trial with 3, 6, and 12 months follow‐up. SETTING : Rural communities. PATIENTS : A total of 182 of 265 frail older patients (52 refused, 2 withdrawn, 27 ineligible, 2 deaths) referred by family practitioners with allocation to intervention (n = 95) or usual care (n = 87). INTERVENTION : Three‐month implementation of CGA recommendations by a Mobile Geriatric Assessment Team (MGAT) with follow‐up assessments at 3, 6, and 12 months. Geriatric nurse assessors, blinded to group assignment, performed each assessment. MAIN OUTCOME MEASURE : Goal Attainment Scaling (GAS). RESULTS : Baseline characteristics were comparable between groups. At 3 months, the intervention group was more likely to attain their goals (GAS total: X̄ = 46.4 ± 5.9; GAS outcome X̄ = 48.0 ± 6.6) compared with controls (total: X̄ = 38.7 ± 4.1; outcome X̄ = 40.8 ± 5.6) ( P < .001). Standard assessments of function (Barthel index, instrumental activities of daily living), cognition (Mini‐Mental State Examination), and quality of life (modified Spitzer quality of life index) showed no difference over 12 months. No difference in survival (intervention: X̄ = 320 days, SE = 6; control: X̄ = 294 days, SE = 6; P = .257) or time to institutionalization (intervention: 340 days, SE = 9; control: 342 days, SE = 8; log rank = 0.661; P = .416) were observed. CONCLUSIONS : A MGAT can target rural dwelling, frail older persons, perform in‐home CGA, and develop an intervention strategy. Although the intervention did not prolong life or delay institutionalization, clinically important benefits were observed.