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Effectiveness of Acute Geriatric Unit Care Using Acute Care for Elders Components: A Systematic Review and Meta‐Analysis
Author(s) -
Fox Mary T.,
Persaud Malini,
Maimets Ilo,
O'Brien Kelly,
Brooks Dina,
Tregunno Deborah,
Schraa Ellen
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12028
Subject(s) - medicine , delirium , acute care , confidence interval , geriatrics , randomized controlled trial , meta analysis , relative risk , emergency medicine , rehabilitation , psychological intervention , intensive care unit , intensive care medicine , physical therapy , health care , nursing , psychiatry , economics , economic growth
Objectives To compare the effectiveness of acute geriatric unit care, based on all or part of the Acute Care for Elders ( ACE ) model and introduced in the acute phase of illness or injury, with that of usual care. Design Systematic review and meta‐analysis of 13 randomized controlled and quasi‐experimental trials with parallel comparison groups retrieved from multiple sources. Setting Acute care geriatric and nongeriatric hospital units. Participants Acutely ill or injured adults (N = 6,839) with an average age of 81. Interventions Acute geriatric unit care characterized by one or more ACE components: patient‐centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment. Measurements Falls, pressure ulcers, delirium, functional decline at discharge from baseline 2‐week prehospital and hospital admission statuses, length of hospital stay, discharge destination (home or nursing home), mortality, costs, and hospital readmissions. Results Acute geriatric unit care was associated with fewer falls (risk ratio ( RR ) = 0.51, 95% confidence interval ( CI ) = 0.29–0.88), less delirium ( RR = 0.73, 95% CI = 0.61–0.88), less functional decline at discharge from baseline 2‐week prehospital admission status ( RR = 0.87, 95% CI = 0.78–0.97), shorter length of hospital stay (weighted mean difference ( WMD ) = −0.61, 95% CI = −1.16 to −0.05), fewer discharges to a nursing home ( RR = 0.82, 95% CI = 0.68–0.99), lower costs ( WMD = −$245.80, 95% CI = −$446.23 to −$45.38), and more discharges to home ( RR = 1.05, 95% CI = 1.01–1.10). A nonsignificant trend toward fewer pressure ulcers was observed. No differences were found in functional decline between baseline hospital admission status and discharge, mortality, or hospital readmissions. Conclusion Acute geriatric unit care, based on all or part of the ACE model and introduced during the acute phase of older adults' illness or injury, improves patient‐ and system‐level outcomes.