Unidad de observación de urgencias para pacientes geriátricos: beneficios clínicos y asistenciales

Pareja, Teresa Fernández; Hornillos, Mercedes; Rodríguez, M.L. Fernández; Martínez, Javier Arce; Madrigal, María Dolores Samper; Mauleón, Coro; Álvarez, Bárbara

doi:10.1016/j.regg.2009.01.007

Cited by 9 publications

(2 citation statements)

References 20 publications

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“…In the geographical area and hospital studied this may indicate that systems to avoid unnecessary admission and to enable early discharge were operating successfully. A variety of alternative models to hospital inpatient care has been described, including short stay assessment units, and intermediate care [37-41]. This study was unable to assess if length of hospital stay was appropriate or justified, or if care could have been provided in other settings.…”

Section: Discussionmentioning

confidence: 99%

Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study

et al. 2014

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BackgroundFrail older people with mental health problems including delirium, dementia and depression are often admitted to general hospitals. However, hospital admission may cause distress, and can be associated with complications. Some commentators suggest that their healthcare needs could be better met elsewhere.MethodsWe studied consecutive patients aged 70 or older admitted for emergency medical or trauma care to an 1800 bed general hospital which provided sole emergency medical and trauma services for its local population. Patients were screened for mental health problems, and those screening positive were invited to take part. 250 participants were recruited and a sub-sample of 53 patients was assessed by a geriatrician for diagnoses, impairments and disabilities, healthcare interventions and outstanding needs.ResultsMedian age was 86 years, median Mini-Mental State Examination score at admission was 16/30, and 45% had delirium. 19% lived in a care home prior to admission. All the patients were complex. A wide range of main admission diagnoses was recorded, and these were usually complicated by falls, immobility, pain, delirium, dehydration or incontinence. There was a median of six active diagnoses, and eight active problems. One quarter of problems was unexplained. A median of 13 interventions was recorded, and a median of a further four interventions suggested by the geriatrician. Those with more severe cognitive impairment had no less medical need.ConclusionsThis patient group, admitted to hospital in the United Kingdom, had numerous healthcare problems, and by implication, extensive healthcare needs. Patients with simpler conditions were not identified, but may have already been rapidly discharged or redirected to non-hospital services by the time assessments were made. To meet the needs of this group outside the hospital would need considerable investment in medical, nursing, therapy and diagnostic facilities. In the meantime, acute hospitals should adapt to deliver comprehensive geriatric assessment, and provide for their mental health needs.

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Section: Discussionmentioning

confidence: 99%

Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study

et al. 2014

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“…ED in-reach models were described in 28 studies describing 27 care models. This included 2 randomised controlled trials, [84,85] 1 randomised controlled trial protocol without results [86], 12 observational studies with a comparator group [87][88][89][90][91][92][93][94][95][96][97][98] and 13 descriptive studies without a comparator group [99][100][101][102][103][104][105][106][107][108][109][110][111]. A detailed description of the care models is provided in Supplementary Table 2C.…”

Section: Ed In-reach Modelsmentioning

confidence: 99%

Acute care models for older people living with frailty: a systematic review and taxonomy

Knight,

Kamwa,

Atkin

et al. 2023

BMC Geriatr

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Background The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear. Methods A systematic review was conducted to derive a taxonomy of acute care models for older people with acute medical illness and describe the outcomes used to assess their effectiveness. Care models providing time-limited episodes of care (up to 14 days) within 48 h of presentation to patients over the age of 65 with acute medical illness were included. Care models based in hospital and community settings were eligible. Searches were undertaken in Medline, Embase, CINAHL and Cochrane databases. Interventions were described and classified in detail using a modified version of the TIDIeR checklist for complex interventions. Outcomes were described and classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Risk of bias was assessed using RoB2 and ROBINS-I. Results The inclusion criteria were met by 103 articles. Four classes of acute care model were identified, acute-bed based care, hospital at home, emergency department in-reach and care home models. The field is dominated by small single centre randomised and non-randomised studies. Most studies were judged to be at risk of bias. A range of outcome measures were reported with little consistency between studies. Evidence of effectiveness was limited. Conclusion Acute care models for older people living with frailty are heterogenous. The clinical effectiveness of these models cannot be conclusively established from the available evidence. Trial registration PROSPERO registration (CRD42021279131).

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Influencia de las unidades de corta estancia en la calidad de la atención hospitalaria en España. Revisión sistemática

Marcos

Hernández-García

Ceballos-Alonso

et al. 2013

Revista de Calidad Asistencial

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Unidad de observación de urgencias para pacientes geriátricos: beneficios clínicos y asistenciales

Cited by 9 publications

References 20 publications

Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study

Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study

Acute care models for older people living with frailty: a systematic review and taxonomy

Influencia de las unidades de corta estancia en la calidad de la atención hospitalaria en España. Revisión sistemática

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