Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
J Am Geriatr Soc. 2010 Jan;58(1):83-92. doi: 10.1111/j.1532-5415.2009.02621.x. Epub 2009 Dec 9.
To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU.
Systematic review and meta-analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors.
GEMUs.
Elderly people admitted to a GEMU.
Quality of the studies was assessed on 10 criteria. The outcome parameters were mortality, institutionalization, functional decline, readmission, and length of stay at different follow-up points. A random-effects meta-analysis was performed using Hedges' gu and variance of relative risk (RR).
GEMUs are organized in a heterogeneous way and the included studies gave no thorough description of comprehensive geriatric assessment (CGA). Involvement of a multidisciplinary team was a key element in all GEMUs. The individual trials showed that admission to a GEMU has one or more favorable effects on the outcomes of interest, with two significant effects in the meta-analysis: less functional decline at discharge from the GEMU (RR=0.87, 95% confidence interval (CI)=0.77-0.99; P=.04) and a lower rate of institutionalization 1 year after discharge (RR=0.78, CI=0.66-0.92; P=.003). For the other outcomes in the meta-analysis, a GEMU did not induce significantly different outcomes than usual care.
This meta-analysis shows a significant effect in favor of the GEMU group on functional decline at discharge and on institutionalization after 1 year. There is heterogeneity between the studies, poor quality of some randomized controlled trials, and shortage of information about CGA. Multidisciplinary CGA offered in a GEMU may add value to the care for frail older persons admitted to the hospital, but the limitations confirm the need for well-designed studies using explicit CGA and more-structured and -coherent assessment instruments such as the Minimum Data Set Resident Assessment Instrument.
探讨老年评估和管理单元（GEMU）的组织方式，并研究入住 GEMU 的效果。
基于对多个数据库文献检索的系统评价和荟萃分析，以及所有已确定文章的参考文献列表，并通过联系作者进行。
GEMU。
入住 GEMU 的老年人。
通过 10 项标准评估研究质量。结局参数为不同随访点的死亡率、住院化、功能下降、再入院和住院时间。使用 Hedges'g 和相对风险（RR）方差进行随机效应荟萃分析。
GEMU 的组织方式存在异质性，纳入的研究没有对全面老年评估（CGA）进行全面描述。多学科团队的参与是所有 GEMU 的关键要素。单项试验表明，入住 GEMU 对关注结局有一个或多个有利影响，荟萃分析中有两个显著影响：从 GEMU 出院时功能下降减少（RR=0.87，95%置信区间（CI）=0.77-0.99；P=.04）和出院后 1 年住院化率降低（RR=0.78，CI=0.66-0.92；P=.003）。荟萃分析中的其他结局，GEMU 并未诱导出与常规护理显著不同的结局。
这项荟萃分析显示，GEMU 组在出院时的功能下降和 1 年后的住院化方面有显著效果。研究之间存在异质性，一些随机对照试验的质量较差，关于 CGA 的信息不足。在 GEMU 中提供多学科 CGA 可能为入住医院的体弱老年人的护理增加价值，但这些局限性证实需要使用明确的 CGA 和更结构化、更一致的评估工具（如最低数据集居民评估工具）进行精心设计的研究。
