© 2002 Evidence-Based Mental Health
Therapeutics
A geriatric evaluation and management programme prevented functional decline and reduced depression in high risk older adults
Boult C, Boult LB, Morishita L, et al. A randomized clinical trial of outpatient geriatric evaluation and management. J Am Geriatr Soc 2001 Apr;49:351–9[Medline]
QUESTION: Can an outpatient geriatric evaluation and management (GEM) programme prevent functional decline and reduce depressive symptoms and Medicare costs in high risk older adults?
Randomised allocation concealed*}
, blinded (outcome assessors)*, controlled trial with 18 months of follow up.
Ramsey County and adjacent zip codes, Minnesota, USA.
568 patients who were 
70 years of age (mean age 79 y, 56% men), community dwelling, and Medicare beneficiaries; and were at high risk for hospital admission and functional decline. Exclusion criteria included living in a nursing home, illness requiring frequent physician visits, and communication barriers. Follow up was 97%.
Patients were allocated to GEM (n=294), consisting of a home visit by a social worker, 2 visits to the GEM clinic, and 6 months of management by an interdisciplinary team, or usual care (n=274) for a mean 6 months. A team comprising a geriatrics nurse practitioner, a geriatrician, a social worker, and a nurse assessed patients, set intervention priorities, created a plan of care, and provided comprehensive care. Patients had monthly clinic visits and regular
New South Wales Institute of Psychiatry, Sydney, New South Wales, Australia
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