Harris R D, Henschke P J, Popplewell P Y, Radford A J, Bond M J, Turnbull R J, Hobbin E R, Chalmers J P, Tonkin A, Stewart A M
Department of Primary Health Care, Flinders Medical Centre, Adelaide, SA.
Aust N Z J Med. 1991 Apr;21(2):230-4. doi: 10.1111/j.1445-5994.1991.tb00448.x.
The aim of this study was to identify differences in the medical management and clinical outcome in a group of elderly patients admitted to a designated geriatric assessment unit (GAU) or to two general medical units (GMUs). A prospective randomised controlled trial was undertaken in 267 patients aged 70 years and over (mean age = 78.3 years). Following discharge from hospital, patients were followed up at three monthly intervals for a total of 12 months. At the time of discharge, no significant differences were found in inpatient management, length of stay, mortality rates, discharge rates to institutional care or utilisation of community services in patients admitted to the GAU and the GMUs. Similarly, no significant differences were found at three, six, nine, and 12 month follow up in case fatality, activities of daily living indices, mental health status, rates of institutional referral and the level of community service support in patients admitted to the GAU and the GMUs studied. These findings do not show any advantage for the unselected 70+ acutely ill elderly patient who is admitted to a designated geriatric assessment unit rather than to a general medical unit. Therefore, an admission policy to GAU, based solely on age 70+ is medically inappropriate and cost-inefficient. Evidence from other sources suggests that an age cohort of acutely admitted patients beyond 80 years may well have returned more optimistic findings for the GAU. In future, GAUs will require a more selective admission policy to maximise the benefits of their rehabilitative and interdisciplinary approach.
本研究的目的是确定入住指定老年评估单元（GAU）或两个普通内科单元（GMU）的一组老年患者在医疗管理和临床结局方面的差异。对267名70岁及以上（平均年龄 = 78.3岁）的患者进行了一项前瞻性随机对照试验。出院后，对患者进行每三个月一次的随访，共随访12个月。出院时，入住GAU和GMU的患者在住院管理、住院时间、死亡率、转至机构护理的出院率或社区服务利用方面未发现显著差异。同样，在对入住GAU和所研究的GMU的患者进行的三个月、六个月、九个月和十二个月随访中，在病死率、日常生活活动指数、心理健康状况、机构转诊率和社区服务支持水平方面也未发现显著差异。这些研究结果并未显示出对于未经过挑选的70岁以上急性病老年患者入住指定老年评估单元而非普通内科单元有任何优势。因此，仅基于70岁以上的年龄制定的GAU入院政策在医学上是不合适的，且成本效益低下。其他来源的证据表明，80岁以上急性入院患者这一年龄组可能会对GAU得出更为乐观的研究结果。未来，GAU将需要更具选择性的入院政策，以最大限度地发挥其康复和多学科方法的益处。
