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Evidence Summary

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Older people hospitalized with an acute illness or injury have fewer falls, delirium or loss of function in acute geriatric units than in usual care

Fox MT, Persaud M, Maimets I, et al. Effectiveness of acute geriatric unit care using acute care for elders components: a systematic review and meta-analysis. J Am Geriatr Soc. 2012;60:2237-45.

Review question

In older people who are hospitalized with an acute illness or injury, does care in an acute geriatric unit help maintain function and reduce complications compared with usual care?

Background

Older people admitted to hospital for an acute (sudden and serious) illness or injury may have complications. They may also lose some of their ability to do some everyday things without help, such as bathe or move about.

Care in special hospital units may reduce complications and help people keep their abilities.

How the review was done

The researchers did a systematic review, searching for studies that were published up to 2012.

They found 10 randomized controlled trials and 3 other studies with 6,839 people (average age 81 years, 62% women).

The key features of the studies were:

  • people were 65 years of age or older and had an acute illness or injury;
  • the acute geriatric hospital unit included at least 1 of the following 5 features: patient-centered care that aimed to help people keep the ability to do everyday activities; frequent checks by doctors or other healthcare providers to reduce adverse effects of treatment; early rehabilitation; early discharge planning; or changes to surroundings to make moving about and understanding things easier; and
  • care in an acute geriatric hospital unit was compared with usual hospital care.

What the researchers found

Compared with usual care, acute geriatric units:

  • reduced falls, delirium and loss of function while in hospital; and
  • reduced length of hospital stay by an average of 1.3 days (although it could be as little as about 5 hours or up to 2.3 days).

Acute geriatric units were no different than usual care for deaths or pressure ulcers (bed sores) while in hospital, or readmissions to hospital up to 3 months after discharge.

Conclusion

In older people who are hospitalized with an acute illness or injury, acute geriatric units reduce falls, delirium and loss of function while in hospital compared with usual hospital care.

Acute geriatric units versus usual hospital care in older people hospitalized with an acute illness or injury

Outcomes in hospital

Number of trials and people

Rate of events with acute geriatric unit care

Rate of events with usual hospital care

Absolute effect of acute geriatric units

Falls

2 trials (749 people)

3.9%

7.7%

About 4 fewer people out of 100 fell in hospital

Delirium

3 trials (1154 people)

17%

23%

About 6 fewer people out of 100 had delirium in hospital

Loss of function*

6 trials (4485 people)

32%

36%

About 5 fewer people out of 100 had a decline in function in hospital

Death

11 trials (6612 people)

5.9%

5.8%

No effect

Pressure ulcers (bed sores)

2 trials (749 people)

4.2%

8.5%

No effect

*Change in ability to do everyday things without help (e.g., eating, bathing, moving about) from before hospital admission until hospital discharge.

†Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different treatments.




Glossary

Delirium
Sudden and severe confusion that often is caused by physical or mental illness. It is usually temporary and reversible.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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