Bastiaan Van Grootven1, Johan Flamaing2,3, Bernadette Dierckx de Casterlé1, Christophe Dubois4,5, Katleen Fagard3, Marie-Christine Herregods4,5, Miek Hornikx6, Annouschka Laenen7, Bart Meuris4,5, Steffen Rex5,8, Jos Tournoy2,3, Koen Milisen1,3, Mieke Deschodt1,3,9. 1. Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium. 2. Department of Clinical and Experimental Medicine, KU Leuven - University of Leuven, Leuven, Belgium. 3. Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium. 4. Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium. 5. Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium. 6. Department of Cardiovascular Diseases, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium. 7. Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven - University of Leuven, Leuven, Belgium. 8. Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium. 9. Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.
Abstract
Background: geriatric consultation teams have failed to impact clinical outcomes prompting geriatric co-management programmes to emerge as a promising strategy to manage frail patients on non-geriatric wards. Objective: to conduct a systematic review of the effectiveness of in-hospital geriatric co-management. Data sources: MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception to 6 May 2016. Reference lists, trial registers and PubMed Central Citations were additionally searched. Study selection: randomised controlled trials and quasi-experimental studies of in-hospital patients included in a geriatric co-management study. Two investigators performed the selection process independently. Data extraction: standardised data extraction and assessment of risk of bias were performed independently by two investigators. Results: twelve studies and 3,590 patients were included from six randomised and six quasi-experimental studies. Geriatric co-management improved functional status and reduced the number of patients with complications in three of the four studies, but studies had a high risk of bias and outcomes were measured heterogeneously and could not be pooled. Co-management reduced the length of stay (pooled mean difference, -1.88 days [95% CI, -2.44 to -1.33]; 11 studies) and may reduce in-hospital mortality (pooled odds ratio, 0.72 [95% CI, 0.50-1.03]; 7 studies). Meta-analysis identified no effect on the number of patients discharged home (5 studies), post-discharge mortality (3 studies) and readmission rate (4 studies). Conclusions: there was low-quality evidence of a reduced length of stay and a reduced number of patients with complications, and very low-quality evidence of better functional status as a result of geriatric co-management.
Background: geriatric consultation teams have failed to impact clinical outcomes prompting geriatric co-management programmes to emerge as a promising strategy to manage frail patients on non-geriatric wards. Objective: to conduct a systematic review of the effectiveness of in-hospital geriatric co-management. Data sources: MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception to 6 May 2016. Reference lists, trial registers and PubMed Central Citations were additionally searched. Study selection: randomised controlled trials and quasi-experimental studies of in-hospital patients included in a geriatric co-management study. Two investigators performed the selection process independently. Data extraction: standardised data extraction and assessment of risk of bias were performed independently by two investigators. Results: twelve studies and 3,590 patients were included from six randomised and six quasi-experimental studies. Geriatric co-management improved functional status and reduced the number of patients with complications in three of the four studies, but studies had a high risk of bias and outcomes were measured heterogeneously and could not be pooled. Co-management reduced the length of stay (pooled mean difference, -1.88 days [95% CI, -2.44 to -1.33]; 11 studies) and may reduce in-hospital mortality (pooled odds ratio, 0.72 [95% CI, 0.50-1.03]; 7 studies). Meta-analysis identified no effect on the number of patients discharged home (5 studies), post-discharge mortality (3 studies) and readmission rate (4 studies). Conclusions: there was low-quality evidence of a reduced length of stay and a reduced number of patients with complications, and very low-quality evidence of better functional status as a result of geriatric co-management.
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Authors: Bastiaan Van Grootven; Lynn McNicoll; Daniel A Mendelson; Susan M Friedman; Katleen Fagard; Koen Milisen; Johan Flamaing; Mieke Deschodt Journal: BMJ Open Date: 2018-03-16 Impact factor: 2.692