title: Effectiveness of acute geriatric unit care using acute care for elders components: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare the effectiveness of acute geriatric unit care, based on all or part of the Acute Care for Elders (ACE) model and introduced in the acute phase of illness or injury, with that of usual care.
  
  
  METHODS
  Systematic review and meta-analysis of 13 randomized controlled and quasi-experimental trials with parallel comparison groups retrieved from multiple sources.
  
  
  METHODS
  Acute care geriatric and nongeriatric hospital units.
  
  
  METHODS
  Acutely ill or injured adults (N = 6,839) with an average age of 81.
  
  
  METHODS
  Acute geriatric unit care characterized by one or more ACE components: patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment.
  
  
  METHODS
  Falls, pressure ulcers, delirium, functional decline at discharge from baseline 2-week prehospital and hospital admission statuses, length of hospital stay, discharge destination (home or nursing home), mortality, costs, and hospital readmissions.
  
  
  RESULTS
  Acute geriatric unit care was associated with fewer falls (risk ratio (RR) = 0.51, 95% confidence interval (CI) = 0.29-0.88), less delirium (RR = 0.73, 95% CI = 0.61-0.88), less functional decline at discharge from baseline 2-week prehospital admission status (RR = 0.87, 95% CI = 0.78-0.97), shorter length of hospital stay (weighted mean difference (WMD) = -0.61, 95% CI = -1.16 to -0.05), fewer discharges to a nursing home (RR = 0.82, 95% CI = 0.68-0.99), lower costs (WMD = -$245.80, 95% CI = -$446.23 to -$45.38), and more discharges to home (RR = 1.05, 95% CI = 1.01-1.10). A nonsignificant trend toward fewer pressure ulcers was observed. No differences were found in functional decline between baseline hospital admission status and discharge, mortality, or hospital readmissions.
  
  
  CONCLUSIONS
  Acute geriatric unit care, based on all or part of the ACE model and introduced during the acute phase of older adults' illness or injury, improves patient- and system-level outcomes.
authors.affiliation: School of Nursing, York University, Toronto, Ontario, Canada. maryfox@yorku.ca
authors.forename: Mary T
authors.initials: MT
authors.lastname: Fox
authors.forename: Malini
authors.initials: M
authors.lastname: Persaud
authors.forename: Ilo
authors.initials: I
authors.lastname: Maimets
authors.forename: Kelly
authors.initials: K
authors.lastname: O'Brien
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
authors.forename: Deborah
authors.initials: D
authors.lastname: Tregunno
authors.forename: Ellen
authors.initials: E
authors.lastname: Schraa
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005853:Geriatrics; D017052:Hospital Mortality; D006757:Hospital Units / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000453:epidemiology; D011787:Quality of Health Care