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Background/Objectives: Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse‐led geriatric co‐management program leads to better functional status at hospital discharge. Design: A quasi‐experimental before‐and‐after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow‐up at 6 months. Setting: Two cardiac care units of the University Hospitals Leuven. Participants: One hundred and fifty‐one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation. Intervention: A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow‐up and coached the cardiac team. A geriatrician co‐managed patients with complications. MEASUREMENTS: The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; one‐point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. RESULTS: The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7–9.3 versus 9.5, 95% CI = 9.2–9.9; p = 0.019) and experienced 18% less functional decline during hospitalization (25% vs. 43%, p = 0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6‐month follow‐up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival. CONCLUSION: This first nurse‐led geriatric co‐management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the responsiveness of the Minimum Data Set inter RAI Acute Care ( AC), a comprehensive geriatric assessment system, to detect clinical changes in patient status during hospital stays. Design An explorative secondary data-analysis comparing prospectively collected data with the inter RAI AC before hospitalization, upon admission, and at discharge. Setting Clinicians from multiple disciplines in nine geriatric and eight nongeriatric wards of nine acute hospitals performed the assessment. Participants The inter RAI AC was administered serially to 256 geriatric inpatients (aged 83.2 ± 5.2; 60% female). Measurements Responsiveness (capacity to detect changes in patients) was calculated for the output scales on five domains: activities of daily living ( ADLs), cognition, communication, depressive symptoms, and pain. Internal responsiveness was evaluated using the Friedman test and Guyatt technique. Results Significant differences in clinical status were found for all five domains, based on the Friedman test. Post hoc tests revealed differences between each assessment period, except for cognition and communication from admission to discharge and for depressive symptoms from before admission to discharge. The Guyatt Responsiveness Index showed good to excellent capacity to detect longitudinal changes during hospitalization for cognition, communication, and pain and substantial performance for ADLs and depressive symptoms. Conclusion In older inpatients, fluctuations in ADLs, cognition, communication, depressive symptoms, and pain can be captured using the inter RAI AC output scales, enabling clinicians to evaluate longitudinal changes from admission to discharge and to provide a comparison with patient status before the acute onset of the illness. These results support the use of these scales in geriatric and nongeriatric wards. [ABSTRACT FROM AUTHOR]