***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: As part of a controlled clinical trial of a geriatric consultation team ( GCT ) , we investigated whether a GCT could affect the incidence of hospital-acquired complications in elderly patients . One hundred eighty-five patients , aged 75 years and older , were r and omized into an intervention ( N = 92 ) and a control ( N = 93 ) group . Members of the intervention group received a GCT consultation and were routinely followed up throughout their hospitalization . The incidence of hospital-acquired complications for the entire study population was 38 % . The type and rate of hospital-acquired complications in the intervention and control groups were not significantly different . Functional status on admission and admission to the psychiatry service were predictive for the occurrence of a hospital-acquired complication . In a broadly selected population such as this , the intensity of care available through a GCT was unable to reduce the occurrence of hospital-acquired complications . However , since this is only one aspect of a GCT function , and others may be of great importance , such aspects , and more targeted population s , must be evaluated before final conclusions can be reached about GCT efficiency BACKGROUND Older persons who re hospitalized for acute illnesses often lose their independence and are discharged to institutions for long-term care . METHODS We studied 651 patients 70 years of age or older who were admitted for general medical care at a teaching hospital ; these patients were r and omly assigned to receive usual care or to be cared for in a special unit design ed to help older persons maintain or achieve independence in self-care activities . The key elements of this program were a specially prepared environment ( with , for example , uncluttered hallways , large clocks and calendars , and h and rails ) ; patient-centered care emphasizing independence , including specific protocol s for prevention of disability and for rehabilitation ; discharge planning with the goal of returning the patient to his or her home ; and intensive review of medical care to minimize the adverse effects of procedures and medications . The main outcome we measured ws the change from admission to discharge in the number of five basic activities of daily living ( bathing , getting dressed , using the toilet , moving from a bed to a chair , and eating ) that the patient could perform independently . RESULTS Twenty-four patients in each group died in the hospital . At the time of discharge , 65 ( 21 percent ) of the 303 surviving patients in the intervention group were classified as much better in terms of their ability to perform basic activities of daily living , 39 ( 13 percent ) as better , 151 ( 50 percent ) as unchanged , 22 ( 7 percent ) as worse , and 26 ( 9 percent ) as much worse . In the usual care group , 40 ( 13 percent ) of the 300 surviving patients were classified as much better , 33 ( 11 percent ) as better , 163 ( 54 percent ) as unchanged , 39 ( 13 percent ) as worse , and 25 ( 8 percent ) as much worse ( P = 0.009 ) . The difference between the groups remained significant ( P = 0.04 ) in a multivariable model in which we controlled for potentially confounding base-line characteristics of the patients . Lengths of stay and hospital charges were similar in the two groups . Fewer patients assigned to the intervention group were discharged to long-term care institutions ( 43 patients [ 14 percent ] , as compared with 67 patients [ 22 percent ] in the usual-care group ; P = 0.01 ) . Among the 493 patients discharged to private homes , similar proportions ( about 10 percent ) in the two groups were admitted to long-term care institutions during the three months after discharge . CONCLUSIONS Specific changes in the provision of acute hospital care can improve the ability of a heterogeneous group of acutely ill older patients to perform basic activities of daily living at the time of discharge from the hospital and can reduce the frequency of discharge to institutions for long-term care Successful models of inpatient geriatric assessment have often involved long hospital stays , specialized interdisciplinary care , and prolonged follow-up , which are difficult to achieve within a prospect i ve payment system . A r and omized clinical trial was undertaken to evaluate the efficacy ( maintenance or improvement in mental , emotional , and physical function ) of using a geriatric assessment process in acute hospital care without increasing hospital charges or lengths of stay .  Four hundred thirty-six patients greater than or equal to 75 years of age were r and omly allocated to treatment ( n = 221 ) or control ( n = 215 ) conditions . Patients in the treatment group were admitted to a special unit and evaluated on admission by an interdisciplinary team , which developed a care plan . Although primary care was provided by the patient 's own physician , the team followed the patients as consultants on the unit in the hospital , and by telephone for 2 months after discharge . The control group was placed on other units and received usual hospital care . The treatment and control groups were similar at study entry . At follow-up , there were no significant differences between the groups with respect to lengths of stay , hospital charges , mortality , change in physical function , or change in mental function . The treatment group changed more often in measured emotional function ( chi 2 = 6.213 , P = .045 ) . This study indicates that it is feasible to implement consultative interdisciplinary team care in the acute-care hospital , but that its efficacy may be limited when applied to an unselected group of older patients BACKGROUND The effects of residence in an acute geriatrics-based ward ( AGW )  with emphasis on early rehabilitation and discharge planning for older patients with acute medical illnesses were assessed . Outcome and use of re sources were compared with those of patients treated in general medical wards ( MWs ) . A per- protocol rather than intention-to-treat analysis was performed . METHODS A r and omized trial with 3-months follow-up . A total of 190 patients aged 70 years and older were r and omized to an acute geriatrics-based ward , and 223 patients were r and omized to general medical wards . RESULTS The two groups were comparable at inclusion . However , after care in the AGW , 71 % of patients could be discharged directly home compared with 64 % of those treated in MWs ( relative risk 1.17 ; 95 % CI , 0.93 - 1.49 ) . The length of stay was shorter in the AGW ( mean 5.9 vs 7.3 days ; P = .002 ) . The proportion of patients in geriatric or other hospital wards or in nursing homes did not differ , but the proportion of AGW patients in sheltered living tended to be lower ( P = .085 ) . At the follow-up , case fatality , ADL function , psychological well-being , need for daily personal assistance , drug consumption , need for readmission to hospital , and total health care costs after discharge did not differ between the two groups . Poor global outcome was observed in 37 % of AGW and 34 % of MW patients . CONCLUSIONS A geriatric approach with greater emphasis on early rehabilitation and discharge planning in the AGW shortened the length of hospital stay and may have reduced the need for long-term institutional living . This occurred despite patients in an acute geriatric ward not having better medical or functional outcome than older acute patients treated in general medical wards OBJECTIVE To evaluate the effect of an Inpatient Geriatric Consultation Team on patient outcome . DESIGN R and omized controlled clinical trial . SETTING A non-academic-affiliated 503-bed community hospital . PATIENTS All in patients over the age of 70 years . Sixty-two patients received multidimensional geriatric assessment , and 58 patients received no intervention .  INTERVENTION Team assessment , leading to formal recommendations to the attending physician . MEASUREMENTS Data were collected on hospital length of stay , referrals to community service , discharge destination , hospital readmissions in 6 months , number of post-discharge physician visits , and change in functional status . Mortality at 6 months and at 1 year was determined for each patient . MAIN RESULTS At 6 months , 12/58 patients ( 21 % ) had died in the control group versus 3/62 ( 6 % ) patients in the experimental group ( P = 0.01 ) . During hospitalization , the length-of-stay was 10.1 days for the control group versus 9.0 days for the experimental group ( P = 0.20 ) . The control group had significantly more readmissions ( 0.6 per patient vs 0.3 per patient , P = 0.02 ) . A higher number of experimental patients , 22 % ( 13/59 ) , showed improvement in ADL scores compared with 7 % ( 4/46 ) of control patients , P = 0.07 . At one year for all r and omized patients , 7/68 ( 10 % ) of experimental patients and 13/64 ( 20 % ) of control patients had died . CONCLUSIONS Short-term mortality can be reduced in community inpatient acute hospital setting s by comprehensive geriatric consultation teams . Important differences in mortality remain at 1 year of followup . Trends towards improved functional status and fewer hospital readmissions favor the intervention group 1 . A dayroom program focused intensively on functional needs and was implemented for confused geriatric in patients who otherwise might have been restrained or required sitters . 2 . There were fewer complications from hospitalization documented for dayroom patients . 3 . There was an increase in family satisfaction regarding the nursing care provided for patients in the alternative environment BACKGROUND Over the past 20 years , both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management . However , the effects of these interventions on survival and functional status remain uncertain . METHODS We conducted a r and omized trial involving frail patients 65 years of age or older who were hospitalized at 11 Veterans Affairs medical centers . After their condition had been stabilized , patients were r and omly assigned , according to a two-by-two factorial design , to receive either care in an inpatient geriatric unit or usual inpatient care , followed by either care at an outpatient geriatric clinic or usual outpatient care . The interventions involved teams that provided geriatric assessment and management according to Veterans Affairs st and ards and published guidelines . The primary outcomes were survival and health-related quality of life , measured with the use of the Medical Outcomes Study 36-Item Short-Form General Health Survey ( SF-36 ) , one year after r and omization . Secondary outcomes were the ability to perform activities of daily living , physical performance , utilization of health services , and costs . RESULTS A total of 1388 patients were enrolled and followed . Neither the inpatient nor the outpatient intervention had a significant effect on mortality ( 21 percent at one year overall ) , nor were there any synergistic effects between the two interventions . At discharge , patients assigned to the inpatient geriatric units had significantly greater improvements in the scores for four of the eight SF-36 subscales , activities of daily living , and physical performance than did those assigned to usual inpatient care . At one year , patients assigned to the outpatient geriatric clinics had better scores on the SF-36 mental health subscale , even after adjustment for the score at discharge , than those assigned to usual outpatient care . Total costs at one year were similar for the intervention and usual-care groups . CONCLUSIONS In this controlled trial , care provided in inpatient geriatric units and outpatient geriatric clinics had no significant effects on survival . There were significant reductions in functional decline with inpatient geriatric evaluation and management and improvements in mental health with outpatient geriatric evaluation and management , with no increase in costs Elderly patients present particular management challenges . We conducted a r and omized clinical trial of the effect of a geriatric consultation service on the management of elderly patients in an acute care hospital . A total of 113 patients aged 75 years or more who met certain criteria were assigned to either receive ( 57 patients ) or not receive ( 56 ) care by the service . At the end of their hospital stay the patients were assessed with regard to predetermined outcomes . The patients were followed up for 1 year after discharge to determine death rates and direct health care expenditures . The intervention group showed significantly greater improvement in mental status ( p less than 0.01 ) , were receiving fewer medications at discharge ( p less than 0.05 ) and had lower short-term death rates ( p less than 0.05 ) than the control group . A geriatric consultation service can improve the hospital care and health of the elderly The structure and function of a newly created interdisciplinary Geriatric Consultation Team ( GCT ) are described . The GCT was introduced on a single medical unit , where consultations were given to 46 consecutive patients aged 75 years and over . The GCT patients had , on the average , 5.5 illnesses and were receiving 3.7 medications .  Anemia ( 50 per cent ) , were hypoalbuminemia ( 65 per cent ) , and elevated blood urea nitrogen ( BUN ) ( 58 per cent ) were frequent . Functional assessment showed frequent dependence on others for assistance with ambulation ( 59 per cent ) , transfers ( 54 per cent ) , and dressing ( 52 per cent ) ; cognitive impairment was found in 52 per cent and clinical depression in 11 per cent of the patients . In comparison with control units , the GCT increased use of physical therapy by 357 per cent , occupational therapy by 390 per cent , and speech therapy by 300 per cent without increasing length of stay . In comparison with control subjects , GCT patients had no decrease in hospital readmission rates ( 43 per cent ) over 10.5 months of follow up . It was concluded that a GCT in an acute-care hospital promotes geriatrics , teaches interdisciplinary teamwork , improves awareness of functional problems of patients , and increases use of rehabilitative services , but does not decrease the high rate of readmission of hospitalized geriatric patients PURPOSE To determine the effectiveness of inpatient interdisciplinary geriatric consultation provided during hospitalization to frail , elderly subjects . SUBJECTS AND SITE : Admission cohort of 197 men admitted from 198 
    Output:
    
Small or no effects were found on patient-related outcomes such as functional performance , length of stay , discharge destination , re source use and costs compared with usual care .
No single best hospital-wide intervention could be identified using strict method ological criteria .
However , several interventions had positive results , and may be used in hospital practice .