The influence of inpatient comprehensive geriatric care on elderly patients with hip fractures: a meta-analysis of randomized controlled trials

Abstract

Objective: To evaluate the efficacy of in-patient comprehensive geriatric care for elderly patients with hip fracture.

Methods: Relevant literatures were searched using the following databases including PubMed, OVID, Web of science, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trails until August 1, 2015. Eligible studies were restricted to randomized controlled trials (RCTs). The available data was extracted by two independent authors and pooled through using Review manager version 5.2. For data deemed not appropriate for synthesis, a narrative overview was conducted.

Results: 15 trials evaluating 3458 participants were identified in our meta-analysis. Our findings indicated patients who underwent comprehensive geriatric cares showed no significant greater improvement than control in in-patient mortality (Odds risk (OR) 0.73, 95% confidence interval (CI) 0.51 to 1.05, P=0.09), 3-(OR 0.96, 95% CI 0.51 to 1.81, P=0.90), 6-(OR 1.03, 95% CI 0.73 to 1.45, P=0.86) and 12-months mortality (OR 0.93, 95% CI 0.77 to 1.12, P=0.30). The proportion of patients who were discharged from hospital to the same place of residence as before the fracture was higher in intervention group than control (OR 1.67, 95% CI 0.80 to 3.37, P=0.0003). In addition, the pooled results showed that the number of patients in intervention group who had regained the same level of activities of daily living (ADL) (43.9% vs 30.2%, 46.0% vs 29.1%) and walking ability (71.3% vs 53.2%, 68.9% vs 56.3%) as before the fracture was higher than control at 3 and 12 months after discharge, respectively.

Conclusion: Comprehensive geriatric care promoted the functional improvement for elderly patients with hip fracture. Meanwhile, the proportion of patients who were discharged from hospital to the same place as before fracture in intervention group was higher as compared to control. However, our finding showed no significant difference on in-patients mortality, follow-up mortality and length of stay between both groups.

Keywords: Comprehensive geriatric care; elderly; inpatient; meta-analysis.

Figure 1

The selection process for the included studies in the meta-analysis.

Figure 2

The methodological quality of included studies.

Figure 3

Effect of inpatient comprehensive geriatric care specifically designed for elderly patients on mortality at hospital (A) and 3-, 6- and 12 months follow up (B).

Figure 4

Effect of inpatient comprehensive geriatric care specifically designed for elderly patients on length of stay (A) and place of residence after discharge (B).

Figure 5

Effect of inpatient comprehensive geriatric care specifically designed for elderly patients on ADL (A) and walking ability (B) at 3- and 12 months follow up.

Figure 6

Funel plot of in-patient mortality (A), mortality at follow up period (B), length of stay (C), place of residence after discharge (D), ADL (E) and walking ability (F) assess publication bias.