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