Editorial| Volume 17, ISSUE 1, P14-15, January 01, 2016

Comprehensive Geriatric Care: Effectiveness as Well as Efficacy

  • Gideon A. Caplan
    Address correspondence to Gideon A. Caplan, MBBS, MD, FRACP, Post-Acute Care Services, Prince of Wales Hospital, Barker Street, Randwick, Australia NSW 2031.
    Department of Geriatric Medicine, Prince of Wales Hospital, Prince of Wales Clinical School, University of New South Wales, and Post Acute Care Services, Prince of Wales Hospital, Sydney, Australia
    Search for articles by this author
Published:November 25, 2015DOI:
      We live and work in the realm of evidence-based medicine. There is more research, randomized controlled trials (RCTs), meta-analyses, systematic reviews, guidelines, and position statements than anyone can possibly read. But geriatricians know, better than most, that the existing evidence is often inappropriate, inaccurate, and inapposite. Grimley Evans
      • Evans J.G.
      Evidence-based and evidence-biased medicine.
      coined the term “evidence biased medicine” to describe the way bad evidence can lead to bad treatment, and bad outcomes.
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        • Evans J.G.
        Evidence-based and evidence-biased medicine.
        Age Ageing. 1995; 24: 461-463
        • Cummings J.L.
        • Morstorf T.
        • Zhong K.
        Alzheimer's disease drug-development pipeline: Few candidates, frequent failures.
        Alzheimers Res Ther. 2014; 6: 37
        • Katritsis D.G.
        • Ioannidis J.P.A.
        Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: A meta-analysis.
        Circulation. 2005; 111: 2906-2912
        • Buchbinder R.
        • Osborne R.H.
        • Ebeling P.R.
        • et al.
        A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.
        N Engl J Med. 2009; 361: 557-568
        • Prasad V.
        • Vandross A.
        • Toomey C.
        • et al.
        A decade of reversal: An analysis of 146 contradicted medical practices.
        Mayo Clin Proc. 2013; 88: 790-798
        • Cochrane A.L.
        Effectiveness and efficiency: random reflection on health services.
        Nuffield Provincial Hospitals Trust, London, United Kingdom1972
        • Van Spall H.G.C.
        • Toren A.
        • Kiss A.
        • Fowler R.A.
        Eligibility criteria of randomized controlled trials published in high-impact general medical journals: A systematic sampling review.
        JAMA. 2007; 297: 1233-1240
        • Morley J.E.
        Osteoporosis and fragility fractures.
        J Am Med Dir Assoc. 2011; 12: 389-392
        • Johnell O.
        • Kanis J.A.
        • Oden A.
        • et al.
        Predictive value of BMD for hip and other fractures.
        J Bone Miner Res. 2005; 20: 1185-1194
        • Stone K.L.
        • Seeley D.G.
        • Lui L.Y.
        • et al.
        BMD at multiple sites and risk of fracture of multiple types: Long-term results from the Study of Osteoporotic Fractures.
        J Bone Miner Res. 2003; 18: 1947-1954
        • Grisso J.A.
        • Kelsey J.L.
        • Strom B.L.
        • et al.
        Risk factors for falls as a cause of hip fracture in women.
        N Engl J Med. 1991; 324: 1326-1331
        • Yu R.
        • Leung J.
        • Woo J.
        Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: Results from the Osteoporotic Fractures in Men (MrOs) Study.
        J Am Med Dir Assoc. 2014; 15: 551-558
        • Martinez-Reig M.
        • Ahmad L.
        • Duque G.
        The orthogeriatric model of care: Systematic review of predictors of institutionalization and mortality in post-hip fracture patients and evidence for interventions.
        J Am Med Dir Assoc. 2012; 13: 770-777
        • Caplan G.A.
        J Am Med Dir Assoc. 2011; 12: 8
        • McVeigh C.L.
        • Caplan G.A.
        Selecting patients for rehabilitation.
        J Am Med Dir Assoc. 2015; 16: 815-816
        • Singh N.A.
        • Quine S.
        • Clemson L.M.
        • et al.
        Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: A randomized controlled trial.
        J Am Med Dir Assoc. 2012; 13: 24-30
        • Quigley P.
        • Bulat T.
        • Kurtzman E.
        • et al.
        Fall prevention and injury protection for nursing home residents.
        J Am Med Dir Assoc. 2010; 11: 284-293
        • Board N.
        • Caplan G.
        Implications of decreasing surgical length of stay.
        Aust Health Rev. 2000; 23: 71-85
        • Robertson M.C.
        • Gardner M.M.
        • Devlin N.
        • et al.
        Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. Part 2: Controlled trial in multiple centres.
        BMJ. 2001; 322: 701-704
        • Bolland M.L.
        • Leung W.
        • Tai V.
        • et al.
        Calcium intake and risk of fracture: Systematic review.
        BMJ. 2015; 351: h4580
        • Bolland M.J.
        • Avenell A.
        • Baron J.A.
        • et al.
        Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: Meta-analysis.
        BMJ. 2010; 341: c3691
        • DIPART Group
        Patient level pooled analysis of 68 500 patients from seven major vitamin D fracture trials in US and Europe.
        BMJ. 2010; 340: b5463
        • Center J.R.
        • Nguyen T.V.
        • Schneider D.
        • et al.
        Mortality after all major types of osteoporotic fracture in men and women: An observational study.
        Lancet. 1999; 353: 878-882
        • Wells G.A.
        • Cranney A.
        • Peterson J.
        • et al.
        Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.
        Cochrane Database Syst Rev. 2008; : CD001155
        • Wells G.A.
        • Cranney A.
        • Peterson J.
        • et al.
        Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.
        Cochrane Database Syst Rev. 2008; : CD004523
        • Crilly R.G.
        • Kloseck M.
        • Chesworth B.
        • et al.
        Comparison of hip fracture and osteoporosis medication prescription rates across Canadian provinces.
        Osteoporos Int. 2014; 25: 205-210
        • Wright R.M.
        Use of osteoporosis medication in older nursing facility residents.
        J Am Med Dir Assoc. 2007; 8: 453-457
        • Stuck A.E.
        • Siu A.L.
        • Wieland D.
        • et al.
        Comprehensive geriatric assessment: A meta-analysis of controlled trials.
        Lancet. 1993; 342: 1032-1036
        • Ellis G.
        • Whitehead M.A.
        • Robinson D.
        • et al.
        Comprehensive geriatric assessment for older adults admitted to hospital: Meta-analysis of randomised controlled trials.
        BMJ. 2011; 343: d6553
        • Liu H.Y.
        • Tseng M.Y.
        • Li H.J.
        • et al.
        Comprehensive care improves physical recovery of hip-fractures in elderly Taiwanese patients with poor nutritional status.
        J Am Med Dir Assoc. 2014; 15: 416-422
        • Lang P.O.
        • Vogt-Ferrier N.
        • Hasso Y.
        Interdisciplinary geriatric and psychiatric care reduces potentially inappropriate prescribing in the hospital: Interventional study in 150 acutely ill elderly patients with mental and somatic comorbid conditions.
        J Am Med Dir Assoc. 2012; 13 (406.e1–e7)
        • Henderson A.
        • Caplan G.A.
        • Daniel A.
        Patient satisfaction: The Australian patient perspective.
        Aust Health Rev. 2004; 27: 73-83
        • Levy C.
        • Palat S.I.
        • Kramer A.M.
        Physician practice patterns in nursing homes.
        J Am Med Dir Assoc. 2007; 8: 558-567
        • Nordstrom P.
        • Michaelsson K.
        • Hommel A.
        • et al.
        Geriatric rehabilitation and discharge location after hip fracture in relation to the risks of death and readmission.
        J Am Med Dir Assoc. 2016; 17: 91.e1-91.e7