Effectiveness of Acute Geriatric Unit Care Using Acute Care for Elders Components: A Systematic Review and Meta-Analysis

摘要: Adults aged 65 and older constitute the “core business” of hospitals.1 Although they represent 13% population in United States2 14% Canada,3 adults account for 43% inpatient hospital days States4 40% Canada.5 This trend is likely to continue given aging.3 During hospitalization an acute event such as illness or injury, are at risk experiencing functional decline iatrogenic complications, including falls, pressure ulcers, delirium, which further contribute decline.6 Hospital-acquired associated with greater expenditures, institutionalization, mortality adults7 even after controlling comorbidity severity.8 Therefore, early intervention (before episode resolved) critical because short length time during persons can recover losses, resume their former lives, avoid institutionalization.9 Dedicated geriatric units, based on a prehabilitation10 function-focused11 model care called Acute Care Elders (ACE), have been designed specifically prevent related complications admitted event.12,13 In response increasingly complex population, some service providers adopted ACE units where admitted.13 However, overall effect unit care, all part introduced phase unclear unquantified. Two systematic reviews conducted,14,15 but authors did not present results meta-analyses, supporting need this current review. Three prior combined data from studies conducted individuals subacute phases;14,16,17 limited validity injury. One meta-analysis18 imputed means missing standard deviations cost length-of-stay outcomes almost 30% included studies,18 may resulted underestimation effect. Last, no meta-analysis indicators quality care.19 The purpose study was determine effectiveness components reducing decline, stay, poor discharge destination outcomes, mortality, costs, readmissions adults.