Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis
Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis
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DOI：
10.1136/bmj.b50
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发表时间：
2009-01-22
影响因子：
105.7
通讯作者：
Rodriguez-Artalejo, Fernando
中科院分区：
文献类型：
--
作者：
Baztan, Juan J.;Suarez-Garcia, Francisco M.;Rodriguez-Artalejo, Fernando
目的评估急性老年病房与常规护理病房相比，在65岁或65岁以上因急性内科疾病入院的成年人中的有效性。设计系统综述和Meta分析。数据来源Medline，Embase和科克伦图书馆，截至2008年8月31日，以及来自已发表文献的参考文献。综述方法随机试验，非随机试验，并纳入病例对照研究。排除基于管理数据库的研究，评估单一疾病护理的研究，评估急性和亚急性监护病房的研究，以及患者入院后3天或3天以上入住急性老年病房的研究。结果共纳入11篇研究，其中随机对照研究5篇，非随机对照研究4篇，病例对照研究2篇。随机试验表明，与入住传统护理病房的老年人相比，入住急性老年病房的老年人出院时功能下降的风险较低（合并优势比0.82，95%置信区间0.68至0.99），出院后更可能住在家里（1.30，1.11至1.52），病死率无差异（0.83，0.60至1.14）。所有研究的全球分析，包括非随机试验，显示了类似的result.Conclusions照顾65岁或以上的人急性内科疾病在急性老年病房产生的功能性效益相比，传统的医院护理，并增加出院后住在家里的可能性。
Objective To assess the effectiveness of acute geriatric units compared with conventional care units in adults aged 65 or more admitted to hospital for acute medical disorders.Design Systematic review and meta- analysis.Data sources Medline, Embase, and the Cochrane Library up to 31 August 2008, and references from published literature.Review methods Randomised trials, non- randomised trials, and case- control studies were included. Exclusions were studies based on administrative databases, those that assessed care for a single disorder, those that evaluated acute and subacute care units, and those in which patients were admitted to the acute geriatric unit after three or more days of being admitted to hospital. Two investigators independently selected the studies and extracted the data.Results 11 studies were included of which five were randomised trials, four non- randomised trials, and two case- control studies. The randomised trials showed that compared with older people admitted to conventional care units those admitted to acute geriatric units had a lower risk of functional decline at discharge ( combined odds ratio 0.82, 95% confidence interval 0.68 to 0.99) and were more likely to live at home after discharge ( 1.30, 1.11 to 1.52), with no differences in case fatality ( 0.83, 0.60 to 1.14). The global analysis of all studies, including non-randomised trials, showed similar results.Conclusions Care of people aged 65 or more with acute medical disorders in acute geriatric units produces a functional benefit compared with conventional hospital care, and increases the likelihood of living at home after discharge.