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Meta-Analysis
. 2022 Apr 1;51(4):afac081.
doi: 10.1093/ageing/afac081.

Effectiveness of acute geriatric unit care on functional decline, clinical and process outcomes among hospitalised older adults with acute medical complaints: a systematic review and meta-analysis

Íde O'Shaughnessy  1 , Katie Robinson  1 , Margaret O'Connor  2   3 , Mairéad Conneely  1 , Damien Ryan  3   4 , Fiona Steed  5 , Leonora Carey  6 , Aoife Leahy  2 , Elaine Shanahan  2 , Colin Quinn  2 , Rose Galvin  1
Affiliations
Meta-Analysis

Effectiveness of acute geriatric unit care on functional decline, clinical and process outcomes among hospitalised older adults with acute medical complaints: a systematic review and meta-analysis

Íde O'Shaughnessy et al. Age Ageing. .

Abstract

Background: the aim of this systematic review and meta-analysis was to update and synthesise the totality of research evidence on the effectiveness of acute geriatric unit (AGU) care for older adults admitted to hospital with acute medical complaints.

Methods: MEDLINE, CINAHL, CENTRAL and Embase databases were systematically searched from 2008 to February 2022. Screening, data extraction and quality grading were undertaken by two reviewers. Only trials with a randomised design comparing AGU care and conventional care units were included. Meta-analyses were performed in Review Manager 5.4 and the Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the certainty of evidence. The primary outcome was incidence of functional decline between baseline 2-week prehospital admission status and discharge and at follow-up.

Results: 11 trials recruiting 7,496 participants across three countries were included. AGU care resulted in a reduction in functional decline at 6-month follow-up (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.66-0.93; moderate certainty evidence) and an increased probability of living at home at 3-month follow-up (RR 1.06, 95% CI 0.99-1.13; high certainty evidence). AGU care resulted in little or no difference in functional decline at hospital discharge or at 3-month follow-up, length of hospital stay, costs, the probability of living at home at discharge, mortality, hospital readmission, cognitive function or patient satisfaction.

Conclusions: AGU care improves clinical and process outcomes for hospitalised older adults with acute medical complaints. Future research should focus on greater inclusion of clinical and patient reported outcome measures.

Keywords: acute geriatric unit; comprehensive geriatric assessment; functional decline; meta-analysis; older adults.

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Figures

Figure 1
Figure 1
PRISMA diagram for updated systematic reviews.
Figure 2
Figure 2
Components of CGA outlined in trials.
Figure 3
Figure 3
Functional decline at discharge from hospital and at 3- and 6-month follow-up.
Figure 4
Figure 4
Living at home at discharge from hospital and at 3-month follow-up.
See this image and copyright information in PMC

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