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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

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b50 (Published 23 January 2009) Cite this as: BMJ 2009;338:b50
  1. Juan J Baztán, consultant geriatrician1,
  2. Francisco M Suárez-García, geriatrician2,
  3. Jesús López-Arrieta, consultant geriatrician3,
  4. Leocadio Rodríguez-Mañas, chief of department4,
  5. Fernando Rodríguez-Artalejo, professor of preventive medicine and public health56
  1. 1Department of Geriatrics, Hospital Central Cruz Roja, Madrid, Spain
  2. 2Health Department, Principado de Asturias, Oviedo, Spain
  3. 3Department of Geriatrics, La Paz-Cantoblanco Universitary Hospital, Madrid, Spain
  4. 4Department of Geriatrics, Universitary Hospital, Getafe, Madrid, Spain
  5. 5Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
  6. 6Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Spain
  1. Correspondence to: J J Baztán jbaztan.hccruzr{at}salud.madrid.org
  • Accepted 22 October 2008

Abstract

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.

Footnotes

  • We thank Mercedes Corrales for her help with the literature search.

  • Contributors: JJB and FRA drafted the manuscript. JJB, FMS, and JLA contributed to the selection of studies and data extraction. All authors contributed to the study design, data analysis, and interpretation of results, and reviewed the manuscript for important intellectual content and approved the final version. JJB is a guarantor.

  • Funding: This study was partially funded by grant No FIS PI05/90212 and research on fragility and the elderly (RETICEF) grant No RD06/0013, Instituto de Salud Carlos III, Ministry of Health and Consumer Affairs.

  • Competing interests: None declared.

  • Ethical approval: Not required.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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