Geriatrics-Focused Systems Offer Limited Benefits to Seniors

TOPLINE:

Compared with traditional primary care systems, geriatrics-focused primary care systems provide better quality of care but fail to improve health and wellness outcomes in older veterans with multiple chronic conditions and social issues.

METHODOLOGY:

• Researchers compared the effects of geriatrics-focused primary care systems with those of traditional primary care systems in 568 patients aged 65 years or older (98.2% men) in the Veterans Affairs healthcare system.
• Slightly more than half of the participants (n = 291) transitioned their care to geriatrics-focused primary care within the 12 months prior to the data pull (exposure period) and had at least two geriatrics-focused primary care visits during the exposure period; the remaining 277 were matched control individuals still receiving care within the traditional primary care system.
• Geriatrics-focused primary care involved clinicians with expertise in geriatrics who could offer comprehensive care to older veterans facing complex health challenges.
• The primary outcome measure was home time, defined as days not spent in hospital units, short-term nursing facilities, inpatient rehabilitation, or emergency visits, within 18 months of the exposure period.
• The secondary outcomes included assessments for falls, incontinence, and function; quality of received medications; and completion of advance directives.

TAKEAWAY:

• Geriatrics-focused vs traditional primary care was associated with higher odds of assessment for falls (odds ratio [OR], 2.86; 95% CI, 1.62-5.04), incontinence (OR, 2.73; 95% CI, 1.69-4.42), and function (OR, 4.05; 95% CI, 2.39-6.85).
• However, over 18 months, the mean number of visits provided by traditional primary care systems was greater than that provided by geriatrics-focused primary care systems (7.4 vs 6.5).
• No significant difference in home time was found between the groups (rate ratio, 0.97; 95% CI, 0.62-1.51) over 18 months post exposure.
• Both geriatrics-focused primary care and traditional care systems were associated with comparable levels of completion of advance directives, medication management, and self-reported health and well-being.

IN PRACTICE:

“[The study] findings are both reassuring and disappointing. They confirm that geriatrics care systems can deliver the quality care processes needed by older persons with multiple chronic conditions and social issues. It should follow, therefore, that the outcomes of this high-quality care would be better than usual care, which was not found in this study,” David B. Reuben, MD, wrote in an accompanying editorial.

“By triaging older patients to a specialized type of care (GeriPACT [geriatrics-focused primary care]), which has additional resources, the work of clinicians providing PACT care [traditional primary care] can be more streamlined and productivity may be improved without additional stress,” he further added.

SOURCE:

This study was led by Susan N. Hastings, MD, MHS, at Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. It was published online on January 16, 2025, in JAMA Network Open.

LIMITATIONS:

There may have been a possibility of unobserved confounding as in any nonrandomized evaluation. The researchers noted that initial patient surveys were conducted after the identification of the treatment group, with no preexposure data on patient-reported outcomes available for inclusion in models. The findings may have been affected by unmeasured structural differences, and the involvement of multidisciplinary team members in geriatrics-focused primary care could not be validated.

DISCLOSURES:

This study was funded by a grant from the Veterans Affairs Health Services Research and Development and a project from the Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham Veterans Affairs Health Care System. Some authors reported receiving grant funding, personal fees, and nonfinancial support from various sources, including the Veterans Health Affairs Office of Research and Development.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.