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Long-term Care/Elderly Health

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Outpatient geriatric evaluation and management programs reduce the burden on caregivers

In recent years, the number of people providing assistance to an older relative or friend has tripled to over 21 million. The burden on these caregivers will likely intensify as health systems shift more and more care to the outpatient arena and growing numbers of older adults strive to maintain their independence.

Fortunately, there is a new model of care delivery that might substantially relieve the caregiving burden on friends and relatives, according to a study supported in part by the Agency for Healthcare Research and Quality (AG/HS11047). The study found that caregivers of adults who received outpatient geriatric evaluation and management (GEM) were half as likely to report an increasing caregiving burden during the 1-year followup as caregivers of adults receiving usual care (17 vs. 39 percent).

GEM begins with an intensive assessment of a frail older adult's medical, psychosocial, and functional capabilities by an interdisciplinary health care team. The team then provides ongoing care, tailoring it to the patient's needs identified during the assessment.

In this study, the GEM team (geriatrician, nurse, social worker, and a gerontological nurse practitioner) met with the patient once a month and provided medical treatment, care management, educational information, counseling, assistance with advance directives, and referral to agencies and other professionals as needed. The team discharged the patient back to the primary care doctor when the patient was adhering to the comprehensive plan of care or GEM treatment goals had been met. The GEM model may protect the caregiver from an increasing burden by providing services intended to reduce a frail older person's functional needs.

In this study, 568 high-risk, community-dwelling older adults were randomized to receive either GEM or usual care for 6 months. In telephone interviews, they assessed at baseline and 1 year later the burden experienced by the patients' informal caregivers. For example, they asked caregivers to what extent they felt they could not meet the care needs of their friend or relative, the extent to which caregiving disrupted their own lives, and the overall time they spent on caregiving.

More details are in "The effects of outpatient geriatric evaluation and management on caregiver burden," by Jennifer L. Weuve, M.P.H., Chad Boult, M.D., M.P.H., and Lynne Morishita, M.S.N., in The Gerontologist 40(4), pp. 429-436, 2000.

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