Specialized geriatric assessment units and their clinical implications.

Geriatric assessment units are among the several innovative responses by members of the US health care system to the many unmet needs facing elderly people who are frail and ill. Based on British models, these units are designed to improve the assessment of medical and psychosocial problems, to provide therapy and rehabilitation, and to determine optimal posttherapy placement at as high a level of independent functioning as possible. While generally similar, the structures and functions of various North American units vary considerably in such areas as type of patients accepted, amount of rehabilitation carried out and type of institutional setting (such as chronic-care hospital, acute-care hospital or outpatient facility). These differences have a bearing on outcomes. Though few experimental studies exist, impacts from the units appear to be substantial, and include more thorough diagnosis, higher levels of patient functioning and improved placement. Physicians can apply several of the lessons from these units to improve their care of elderly patients.