Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria Di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy.
Department of Medicine and Surgery, University of Parma, Parma, Italy.
Aging Clin Exp Res. 2022 Mar;34(3):599-609. doi: 10.1007/s40520-021-01967-z. Epub 2021 Sep 1.
Geriatric rapid observation units may represent an alternative to hospitalization in older patients with non-critical acute illness.
To describe the characteristics and outcomes of patients admitted to a geriatric observation unit called URGe (Unità Geriatrica Rapida), implemented in an Italian hospital and characterized by multidisciplinary medical staff with geriatric expertise, fast-track access to diagnostic resources, regular use of point-of-care ultrasound and predicted length of stay (LOS) < 72 h.
The medical records of patients admitted to URGe during a 3-month period (452 subjects, 247 F and 205 M, median age 82 years, IQR 77-87) were retrospectively examined. The primary study endpoint was transferral from URGe to regular wards. Baseline covariates included demographics, comprehensive geriatric assessment, acute illnesses, comorbidities, vital signs and routine laboratory tests.
Despite elevated burden of multimorbidity (median number of chronic diseases 4, IQR 2-5) and frailty (median Rockwood Clinical Frailty Scale score 4, IQR 3-6), only 137 patients (30.3%) required transferral from URGe to regular wards. The main factors positively associated with this outcome were Rockwood score, fever, cancer and red cell distribution width (P < 0.05 on multivariate logistic regression model). The rate of complications (mortality, delirium, and falls) during URGe stay was low (0.5%, 7% and 2%, respectively). Overall duration of hospital stay was lower than that of a group of historical controls matched by age, sex, main diagnosis, multimorbidity and frailty.
The URGe model of acute geriatric care is feasible, safe and has the potential of reducing unnecessary hospitalizations of older patients.
老年快速观察病房可能代表了一种替代方案，用于治疗非危急的急性疾病的老年患者。
描述在意大利一家医院实施的名为 URGe（快速老年病房）的老年观察病房的患者特征和结局。该病房的特点是拥有多学科的老年医学专业医疗团队、快速获得诊断资源、定期使用即时检验超声以及预计住院时间（ LOS ）<72 小时。
回顾性检查了 URGe 病房在三个月期间（共 452 名患者，247 名女性和 205 名男性，中位年龄 82 岁，IQR 为 77-87）的住院记录。主要研究终点是从 URGe 病房转至普通病房。基线协变量包括人口统计学数据、全面老年评估、急性疾病、合并症、生命体征和常规实验室检查。
尽管存在多种合并症（中位慢性疾病数为 4 种，IQR 为 2-5）和衰弱（中位 Rockwood 临床衰弱量表评分为 4 分，IQR 为 3-6）的高负担，但仅有 137 名患者（30.3%）需要从 URGe 病房转至普通病房。与这一结果呈正相关的主要因素是 Rockwood 评分、发热、癌症和红细胞分布宽度（多变量逻辑回归模型 P<0.05）。URGe 病房住院期间并发症（死亡率、谵妄和跌倒）的发生率较低（分别为 0.5%、7%和 2%）。总的住院时间短于一组按年龄、性别、主要诊断、合并症和衰弱情况匹配的历史对照患者。
急性老年护理的 URGe 模式是可行的、安全的，并且有可能减少老年患者不必要的住院治疗。
