Íde O'Shaughnessy1, Katie Robinson1, Margaret O'Connor2,3, Mairéad Conneely1, Damien Ryan3,4, Fiona Steed5, Leonora Carey6, Aoife Leahy2, Elaine Shanahan2, Colin Quinn2, Rose Galvin1. 1. School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland. 2. Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland. 3. School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland. 4. Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland. 5. Medicine Directorate, University Hospital Limerick, Limerick, Ireland. 6. Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland.
Abstract
BACKGROUND: the aim of this systematic review and meta-analysis was to update and synthesise the totality of research evidence on the effectiveness of acute geriatric unit (AGU) care for older adults admitted to hospital with acute medical complaints. METHODS: MEDLINE, CINAHL, CENTRAL and Embase databases were systematically searched from 2008 to February 2022. Screening, data extraction and quality grading were undertaken by two reviewers. Only trials with a randomised design comparing AGU care and conventional care units were included. Meta-analyses were performed in Review Manager 5.4 and the Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the certainty of evidence. The primary outcome was incidence of functional decline between baseline 2-week prehospital admission status and discharge and at follow-up. RESULTS: 11 trials recruiting 7,496 participants across three countries were included. AGU care resulted in a reduction in functional decline at 6-month follow-up (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.66-0.93; moderate certainty evidence) and an increased probability of living at home at 3-month follow-up (RR 1.06, 95% CI 0.99-1.13; high certainty evidence). AGU care resulted in little or no difference in functional decline at hospital discharge or at 3-month follow-up, length of hospital stay, costs, the probability of living at home at discharge, mortality, hospital readmission, cognitive function or patient satisfaction. CONCLUSIONS: AGU care improves clinical and process outcomes for hospitalised older adults with acute medical complaints. Future research should focus on greater inclusion of clinical and patient reported outcome measures.
BACKGROUND: the aim of this systematic review and meta-analysis was to update and synthesise the totality of research evidence on the effectiveness of acute geriatric unit (AGU) care for older adults admitted to hospital with acute medical complaints. METHODS: MEDLINE, CINAHL, CENTRAL and Embase databases were systematically searched from 2008 to February 2022. Screening, data extraction and quality grading were undertaken by two reviewers. Only trials with a randomised design comparing AGU care and conventional care units were included. Meta-analyses were performed in Review Manager 5.4 and the Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the certainty of evidence. The primary outcome was incidence of functional decline between baseline 2-week prehospital admission status and discharge and at follow-up. RESULTS: 11 trials recruiting 7,496 participants across three countries were included. AGU care resulted in a reduction in functional decline at 6-month follow-up (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.66-0.93; moderate certainty evidence) and an increased probability of living at home at 3-month follow-up (RR 1.06, 95% CI 0.99-1.13; high certainty evidence). AGU care resulted in little or no difference in functional decline at hospital discharge or at 3-month follow-up, length of hospital stay, costs, the probability of living at home at discharge, mortality, hospital readmission, cognitive function or patient satisfaction. CONCLUSIONS: AGU care improves clinical and process outcomes for hospitalised older adults with acute medical complaints. Future research should focus on greater inclusion of clinical and patient reported outcome measures.
Authors: K Asplund; Y Gustafson; C Jacobsson; G Bucht; A Wahlin; J Peterson; J O Blom; K A Angquist Journal: J Am Geriatr Soc Date: 2000-11 Impact factor: 5.562
Authors: M A Sager; M A Rudberg; M Jalaluddin; T Franke; S K Inouye; C S Landefeld; H Siebens; C H Winograd Journal: J Am Geriatr Soc Date: 1996-03 Impact factor: 5.562
Authors: R D Harris; P J Henschke; P Y Popplewell; A J Radford; M J Bond; R J Turnbull; E R Hobbin; J P Chalmers; A Tonkin; A M Stewart Journal: Aust N Z J Med Date: 1991-04
Authors: Matthew J Page; Joanne E McKenzie; Patrick M Bossuyt; Isabelle Boutron; Tammy C Hoffmann; Cynthia D Mulrow; Larissa Shamseer; Jennifer M Tetzlaff; Elie A Akl; Sue E Brennan; Roger Chou; Julie Glanville; Jeremy M Grimshaw; Asbjørn Hróbjartsson; Manoj M Lalu; Tianjing Li; Elizabeth W Loder; Evan Mayo-Wilson; Steve McDonald; Luke A McGuinness; Lesley A Stewart; James Thomas; Andrea C Tricco; Vivian A Welch; Penny Whiting; David Moher Journal: BMJ Date: 2021-03-29