Effectiveness of Acute Geriatric Unit Care Using Acute Care for Elders Components: A Systematic Review and Meta‐Analysis

Abstract

ObjectivesTo 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.DesignSystematic review and meta-analysis of 13 randomized controlled and quasi-experimental trials with parallel comparison groups retrieved from multiple sources.SettingAcute care geriatric and nongeriatric hospital units.ParticipantsAcutely ill or injured adults (N = 6,839) with an average age of 81.InterventionsAcute geriatric unit care characterized by one or more ACE components: patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment.MeasurementsFalls, 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.ResultsAcute 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.ConclusionAcute 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.

Revisión sistemática de literatura. Declinación funcional en ancianos hospitalizados

“…Las intervenciones están dirigidas a modificar el entorno, cuidado centrado en el anciano, asegurar la adherencia al tratamiento, protocolos para prevenir y rehabilitar pacientes con DF y diseño del egreso geriátrico planeado (52,56). Teóricamente el modelo puede ser implementado en cualquier unidad hospitalaria que atiende ancianos, pero requeriría de las modificaciones del entorno y la presencia del equipo interdisciplinario que disponga de un líder que pertenezca al equipo (57).…”

Ethical issues for older people in the emergency department

“…There is high quality evidence supporting the benefits of CGA as an effective intervention for older adults as a means of reducing rates of deterioration, death and institutionalisation compared to those receiving standard medical care (14)(15)(16). The evidence to-date points towards defined ward areas delivering CGA being more effective than liaison services (14)(15)(16)(17), which is challenging to delivered in the ED setting.…”

“…The evidence to-date points towards defined ward areas delivering CGA being more effective than liaison services (14)(15)(16)(17), which is challenging to delivered in the ED setting. There are emerging models of appear to show improved service related outcomes (e.g.…”

Geriatrics Evaluation and Management in the Veterans Administration– An Historical Perspective

“…In addition, the ACE model was associated with fewer falls, less delirium, and less functional decline. 5 Mobile ACE Units (MACE), acute care geriatric services without a geographic bed location, have since been shown to have similar outcomes. 6 The VA requires availability of geriatric evaluation services for all military veterans as mandated in the 1999 Veterans Millennium Healthcare and Benefits Act (Mill Bill), and these services may currently be located in inpatient, long-term care -community living center (CLC), or outpatient settings.…”