Effectiveness of Acute Geriatric Unit Care Using Acute Care for Elders Components: A Systematic Review and Meta-Analysis
Effectiveness of Acute Geriatric Unit Care Using Acute Care for Elders Components: A Systematic Review and Meta-Analysis
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DOI：
10.1111/jgs.12028
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发表时间：
2012-12-01
影响因子：
6.3
通讯作者：
Schraa, Ellen
中科院分区：
文献类型：
--
作者：
Fox, Mary T.;Persaud, Malini;Schraa, Ellen
目的比较急性老年单元护理的有效性，基于全部或部分急性老年护理（ACE）模式，并在疾病或损伤的急性期引入，设计对13例随机对照和准随机对照的患者进行系统回顾和荟萃分析。从多个来源检索的平行对照组的实验性试验。设置急性护理老年和非老年医院单位。参与者平均年龄为81岁的急性疾病或受伤的成年人（N= 6，839）。干预急性老年病房护理的特征是一种或多种ACE成分：以患者为中心的护理，频繁的医疗检查，早期康复，早期出院计划，准备好的环境。出院时测量福尔斯、压疮、谵妄、功能下降，从基线到2周院前和入院状态，住院时间、出院目的地结果急性老年病房护理与更少的福尔斯有关（风险比（RR）=0.51，95%置信区间（CI）= 0.29 - 0.88），谵妄较少（RR=0.73，95% CI=0.610.88），出院时功能下降较基线2周院前入院状态更少（RR=0.87，95%CI = 0.78 - 0.97），住院时间缩短（加权平均差（WMD）=-0.61，95%CI =-1.16至-0.05），较少出院到疗养院（RR=0.82，95% CI=0.680.99），较低的费用（WMD=-245.80，95% CI=-446.23 ~-45.38），更多的出院回家（RR=1.05，95% CI=1.011.10）。观察到压疮较少的非显著趋势。基线入院状态和出院，死亡率，或医院rerections.Conclusion急性老年病房护理，根据全部或部分的ACE模型，并在急性期的老年人的疾病或损伤，提高患者和系统水平的结果之间的功能下降没有差异。J Am Geriatr Soc 60：2237-2245，2012.
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)=0.290.88), less delirium (RR=0.73, 95% CI=0.610.88), less functional decline at discharge from baseline 2-week prehospital admission status (RR=0.87, 95% CI=0.780.97), 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=0.680.99), lower costs (WMD=-$245.80, 95% CI=-$446.23 to -$45.38), and more discharges to home (RR=1.05, 95% CI=1.011.10). 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. J Am Geriatr Soc 60:2237-2245, 2012.