title: The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU.
  
  
  METHODS
  Systematic review and meta-analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors.
  
  
  METHODS
  GEMUs.
  
  
  METHODS
  Elderly people admitted to a GEMU.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Katleen
authors.initials: K
authors.lastname: Van Craen
authors.forename: Tom
authors.initials: T
authors.lastname: Braes
authors.forename: Nathalie
authors.initials: N
authors.lastname: Wellens
authors.forename: Kris
authors.initials: K
authors.lastname: Denhaerynck
authors.forename: Johan
authors.initials: J
authors.lastname: Flamaing
authors.forename: Philip
authors.initials: P
authors.lastname: Moons
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Christiane
authors.initials: C
authors.lastname: Gosset
authors.forename: Jean
authors.initials: J
authors.lastname: Petermans
authors.forename: Koen
authors.initials: K
authors.lastname: Milisen
mesh_terms: D000368:Aged; D015577:Geriatric Assessment; D006801:Humans; D007297:Inpatients