School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Limerick, Ireland
School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Limerick, Ireland.
BMJ Open. 2021 Oct 27;11(10):e050524. doi: 10.1136/bmjopen-2021-050524.
Older adults are clinically heterogeneous and are at increased risk of adverse outcomes during hospitalisation due to the presence of multiple comorbid conditions and reduced homoeostatic reserves. Acute geriatric units (AGUs) are units designed with their own physical location and structure, which provide care to older adults during the acute phase of illness and are underpinned by an interdisciplinary comprehensive geriatric assessment model of care. This review aims to update and synthesise the totality of evidence related to the effectiveness of AGU care on clinical and process outcomes among older adults admitted to hospital with acute medical complaints.
Updated systematic review and meta-analysis METHODS AND ANALYSIS: MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Controlled Trials in the Cochrane Library and Embase electronic databases will be systematically searched from 2008 to February 2021. Trials with a randomised design that deliver an AGU intervention to older adults admitted to hospital for acute medical complaints will be included. The primary outcome measure will be functional decline at discharge from hospital and at follow-up. Secondary outcomes will include length of stay, cost of index admission, incidence of unscheduled hospital readmission, living at home (the inverse of death or institutionalisation combined; used to describe someone who is in their own home at follow-up), mortality, cognitive function and patient satisfaction with index admission. Title and abstract screening of studies for full-text extraction will be conducted independently by two authors. The Cochrane risk of bias 2 tool will be used to assess the methodological quality of the included trials. The quality of evidence for outcomes reported will be assessed using the Grading of Recommendations Assessment, Development and Evaluations framework. A pooled meta-analysis will be conducted using Review Manager, depending on the uniformity of the data.
Formal ethical approval is not required as all data collected will be secondary data and will be analysed anonymously. The authors will present the findings of the review to a patient and public involvement stakeholder panel of older adults that has been established at the Ageing Research Centre in the University of Limerick. This will enable the views and opinions of older adults to be integrated into the discussion section of the paper.
CRD42021237633.
老年人临床表现存在较大差异，且常患有多种合并症，内稳态储备减少，因此住院期间发生不良结局的风险增加。急性老年病单元（AGU）是一种具有特定物理位置和结构的单元，为急性疾病期间的老年人提供医疗服务，并以综合老年医学评估护理模式为基础。本综述旨在更新并综合有关 AGU 护理对因急性内科疾病住院的老年人临床和过程结局影响的所有证据。
更新的系统评价和荟萃分析
将从 2008 年至 2021 年 2 月，系统检索 MEDLINE、护理学和联合健康文献累积索引、Cochrane 图书馆对照试验和 Embase 电子数据库，纳入对因急性内科疾病住院的老年人实施 AGU 干预的随机设计试验。主要结局指标为出院时和随访时的功能下降。次要结局指标包括住院时间、指数入院的成本、非计划性再入院的发生率、居家生活（死亡或机构化的反面；用于描述随访时居住在自己家中的人）、死亡率、认知功能和对指数入院的满意度。将由两名作者独立筛选研究的标题和摘要，以提取全文。将使用 Cochrane 偏倚风险 2 工具评估纳入试验的方法学质量。将使用推荐评估、制定与评价分级框架评估报告结局的证据质量。将根据数据的一致性使用 Review Manager 进行汇总荟萃分析。
由于所有收集的数据均为二次数据且将进行匿名分析，因此无需进行正式的伦理批准。作者将向在利默里克大学老龄化研究中心成立的老年患者和公众利益相关者小组展示该综述的研究结果。这将使老年人的观点和意见能够纳入论文的讨论部分。
PROSPERO 注册号：CRD42021237633。
