Acutegeriatricunits improve functional outcomes after hospital care
ST LOUIS , 09 feb 2009 - For older adults with acute medical problems, care in an acutegeriatricunit reduces the risk of functional decline and increases the likelihood of living at home after discharge, according to a meta-analysis published February 7, 2009 by the British Medical Journal.
The investigators performed a systematic review of the literature to identify randomized and non-randomized trials and case-control studies comparing the effectiveness of acutegeriatricunits with conventional hospital care for adults 65 and older hospitalized for acute medical disorders. Acutegeriatricunits were defined as distinct hospital units operated by specialized multidisciplinary teams who provided care for elderly inpatients.
The review excluded studies based on administrative data, confined to a single diagnosis, of acute and subacute care units, and with admission to the acutegeriatricunit after 4 or more days in the hospital. Meta-analysis focused on the outcomes of functional decline, living at home, and case fatality at discharge and 3 months' follow-up. The lead author was Juan J. Baztán of Hospital Central Cruz Roja, Madrid.
The review identified a total of 11 studies, including 5 randomized trials, 4 non-randomized trials, and 2 case-control studies. Study quality was variable, particularly for the non-randomized trials.
On meta-analysis of randomized trial data, admission to the acutegeriatricunit was associated with a reduced rate of functional decline at discharge, compared to conventional hospital care: odds ratio 0.82. Patients receiving acutegeriatricunit care were also more likely to return to living at home after discharge, odds ratio 1.30, with no difference in the case-fatality rate. Analysis including data from all studies, including the non-randomized trials, yielded similar results.
To reduce the changes of functional decline, hospital care for older adults with acute medical problems should include comprehensive assessment by multidisciplinary teams. Several types of interventions have been proposed to improve the efficiency and effectiveness of hospital care for this group of patients. However, only one previous review has focused specifically on acutegeriatricunits.
Care in acutegeriatricunits improves functional outcomes for patients aged 65 or older with acute medical problems, the new review and meta-analysis concludes. Compared to conventional hospital care, patients treated on the acutegeriatricunit have an 18% reduction in the risk of functional decline and a 30% increase in the likelihood of living at home after discharge. The researchers call for further studies to evaluate the medium-term effects of acutegeriatricunits on functional decline, including the specific components of care associated with improved functional outcomes.