Acute Care for Elders Components of Acute Geriatric Unit Care: Systematic Descriptive Review
Acute Care for Elders Components of Acute Geriatric Unit Care: Systematic Descriptive Review
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DOI：
10.1111/jgs.12282
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发表时间：
2013-06-01
影响因子：
6.3
通讯作者：
O'Brien, Kelly
中科院分区：
文献类型：
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作者：
Fox, Mary T.;Sidani, Souraya;O'Brien, Kelly
目的描述急性老年护理（ACE）模式的组成部分，实施急性老年病房护理的一部分，并探讨每个ACE组件和医源性并发症，功能下降，住院时间，疗养院出院，成本和出院回家的结果之间的关联。设计对32篇文章进行系统描述性综述，包括14项报告ACE组分实施或其实施在改善结局方面的有效性的试验。使用试验结局数据计算平均效应量（ES）。使用内容分析法对描述试验中ACE组件实施的信息进行分析。设置急性护理老年病房。急性病或受伤的成年人（N= 6，839），平均年龄为81岁。急性老年病房护理的特点是实施一个或多个ACE组件：医疗审查，早期康复，早期出院计划，准备环境，以病人为中心的护理。测量福尔斯、压疮、谵妄、功能下降、住院时间、出院目的地（家庭或疗养院）和费用。结果：医疗复查、早期康复和以患者为中心的护理，其特征是实施标准化和个性化的以功能为中心的干预措施，在所有结局中的平均标准化平均ES（所有ES=0.20）大于早期出院计划（ES=0.17）或准备好的环境（ES=0.11）。结论：医疗复查、早期康复和以患者为中心的护理等特定ACE成分干预似乎是总体积极结局的最佳选择。这些发现可以帮助服务提供者在各自机构的背景下设计和评估最有效的ACE模型，以改善急性疾病或受伤老年人的结局。
Objectives To describe the Acute Care for Elders (ACE) model components implemented as part of acute geriatric unit care and explore the association between each ACE component and outcomes of iatrogenic complications, functional decline, length of hospital stay, nursing home discharges, costs, and discharges home. Design Systematic descriptive review of 32 articles, including 14 trials reporting on the implementation of ACE components or the effectiveness of their implementation in improving outcomes. Mean effect sizes (ESs) were calculated using trial outcome data. Information describing implementation of the ACE components in the trials was analyzed using content analysis. Setting Acute care geriatric units. Participants Acutely ill or injured adults (N=6,839) with an average age of 81. Interventions Acute geriatric unit care was characterized by the implementation of one or more ACE components: medical review, early rehabilitation, early discharge planning, prepared environment, patient-centered care. Measurements Falls, pressure ulcers, delirium, functional decline, length of hospital stay, discharge destination (home or nursing home), and costs. Results Medical review, early rehabilitation, and patient-centered care, characterized by the implementation of standardized and individualized function-focused interventions, had larger standardized mean ESs (all ES=0.20) averaged across all outcomes, than did early discharge planning (ES=0.17) or prepared environment (ES=0.11). Conclusion Specific ACE component interventions of medical review, early rehabilitation, and patient-centered care appear to be optimal for overall positive outcomes. These findings can help service providers design and evaluate the most-effective ACE model within the contexts of their respective institutions to improve outcomes for acutely ill or injured older adults.