School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland.
Age Ageing. 2022 Apr 1;51(4). doi: 10.1093/ageing/afac081.
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.
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.
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.
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.
本系统评价和荟萃分析的目的是更新和综合关于急性老年科病房（AGU）对因急性内科疾病住院的老年人的有效性的所有研究证据。
从 2008 年到 2022 年 2 月，系统地检索了 MEDLINE、CINAHL、CENTRAL 和 Embase 数据库。两名评审员进行了筛选、数据提取和质量分级。仅纳入了比较 AGU 护理和常规护理单元的随机设计试验。使用 Review Manager 5.4 进行荟萃分析，并使用推荐评估、制定和评估分级框架评估证据的确定性。主要结局是从基线到住院前 2 周和出院时以及随访时的功能下降发生率。
纳入了来自三个国家的 11 项试验，共 7496 名参与者。AGU 护理可降低 6 个月随访时的功能下降发生率（风险比（RR）0.79，95%置信区间（CI）0.66-0.93；中等确定性证据），并增加 3 个月随访时居家生活的可能性（RR 1.06，95% CI 0.99-1.13；高确定性证据）。AGU 护理在出院时或 3 个月随访时的功能下降、住院时间、成本、出院时居家生活的可能性、死亡率、医院再入院、认知功能或患者满意度方面，差异较小或无差异。
AGU 护理可改善因急性内科疾病住院的老年人的临床和过程结局。未来的研究应更加注重纳入临床和患者报告的结局测量。
