Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials.
Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials.
复制标题
DOI：
10.1136/bmj.d6553
复制
发表时间：
2011-10-27
期刊：
影响因子：
--
通讯作者：
Langhorne P
中科院分区：
文献类型：
--
作者：
Ellis G;Whitehead MA;Robinson D;O'Neill D;Langhorne P
目的评价老年急诊住院患者住院综合老年评估的效果。检索策略我们检索了EPOC注册中心、Cochrane‘s对照试验注册中心、效应综述摘要数据库(DARE)、Medline、Embase、CINAHL、AARP Ageline，以及手工搜索的高产出期刊。选择标准综合老年评估的随机对照试验(无论是由流动小组进行还是在指定病房进行)与常规护理相比。老年综合评估是一个多维的跨学科诊断过程，用于确定虚弱老年人的医疗、心理和功能能力，以制定协调和综合的治疗计划和长期随访。数据收集和分析三名独立审查员评估了资格和试验质量，并提取了已发表的数据。另外两名审查员进行了主持。结果对6个国家的10名 315参与者进行了22项试验。对于主要结果“居家生活”，接受综合老年评估的患者在预定的随访结束时更有可能活着并在自己的家里(中位数随访12个月时的优势比1.16(95%可信区间1.05至1.28；P=0.003；需要治疗的人数33)与接受一般医疗护理的患者相比(中位数随访6个月时的优势比1.25(1.11至1.42；P<；0.001；需要治疗的人数17))。此外，患者不太可能住在养老院(分别为0.78、0.69和0.88；P<；0.001)。小组互动表明，小组“WARD”和“团队”之间存在有利于WARD的差异。在综合老年评估组中，患者死亡或恶化的可能性也较小(0.76，0.64至0.9；P=0.001)，而认知能力更有可能改善(标准化平均差异为0.08，0.01至0.15；P=0.02)。结论全面的老年评估增加了患者在紧急入院后活着和在家中的可能性。对于指定用于综合老年评估的病房的试验似乎尤其如此，与一般医疗保健相比，这与潜在的成本降低有关。
Objective To evaluate the effectiveness of comprehensive geriatric assessment in hospital for older adults admitted as an emergency. Search strategy We searched the EPOC Register, Cochrane’s Controlled Trials Register, the Database of Abstracts of Reviews of Effects (DARE), Medline, Embase, CINAHL, AARP Ageline, and handsearched high yield journals. Selection criteria Randomised controlled trials of comprehensive geriatric assessment (whether by mobile teams or in designated wards) compared with usual care. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process used to determine the medical, psychological, and functional capabilities of a frail elderly person to develop a coordinated and integrated plan for treatment and long term follow-up. Data collection and analysis Three independent reviewers assessed eligibility and trial quality and extracted published data. Two additional reviewers moderated. Results Twenty two trials evaluating 10 315 participants in six countries were identified. For the primary outcome “living at home,” patients who underwent comprehensive geriatric assessment were more likely to be alive and in their own homes at the end of scheduled follow-up (odds ratio 1.16 (95% confidence interval 1.05 to 1.28; P=0.003; number needed to treat 33) at a median follow-up of 12 months versus 1.25 (1.11 to 1.42; P<0.001; number needed to treat 17) at a median follow-up of six months) compared with patients who received general medical care. In addition, patients were less likely to be living in residential care (0.78, 0.69 to 0.88; P<0.001). Subgroup interaction suggested differences between the subgroups “wards” and “teams” in favour of wards. Patients were also less likely to die or experience deterioration (0.76, 0.64 to 0.90; P=0.001) and were more likely to experience improved cognition (standardised mean difference 0.08, 0.01 to 0.15; P=0.02) in the comprehensive geriatric assessment group. Conclusions Comprehensive geriatric assessment increases patients’ likelihood of being alive and in their own homes after an emergency admission to hospital. This seems to be especially true for trials of wards designated for comprehensive geriatric assessment and is associated with a potential cost reduction compared with general medical care.
登录
查看更多内容
DOI：
10.1136/bmj.c1718
发表时间：
2010-04-20
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Bachmann S;Finger C;Huss A;Egger M;Stuck AE;Clough-Gorr KM
通讯作者：
Clough-Gorr KM
影响因子：
158.5
作者：
Cohen, HJ;Feussner, JR;Brodkin, K
通讯作者：
Brodkin, K
影响因子：
120.7
作者：
ALLEN, CM;BECKER, PM;COHEN, HJ
通讯作者：
COHEN, HJ
影响因子：
39.2
作者：
MCVEY, LJ;BECKER, PM;COHEN, HJ
通讯作者：
COHEN, HJ
DOI：
10.1093/gerona/glq069
发表时间：
2010-08-01
影响因子：
5.1
作者：
Mudge, Alison M.;O'Rourke, Peter;Denaro, Charles P.
通讯作者：
Denaro, Charles P.