title: Operating a Monitoring Unit in the Geriatric Department: Effects on Outcomes.
abstract: OBJECTIVE
  To compare the effect of a five-bed geriatric monitoring unit (MU) on in-hospital mortality and length of stay with the effect of usual care in a geriatric hospital department and a medical MU.
  
  
  METHODS
  Prospective, case-control, noninterventional study.
  
  
  METHODS
  All individuals hospitalized for 24 hours or longer in the geriatric MU (n = 89, aged 53-101, mean age 82.2 ± 9.6) over a period of 5 months (January-May 2015); individuals admitted to the geriatric department (n = 178, aged 55-100, mean age 83.2 ± 9.8), matched at a ratio of 1:2 according to sex, age ±5 years, and need for mechanical ventilation; and individuals admitted to a similar five-bed medical MU (n = 95, aged 35-90, mean age 68.2 ± 14.4) during the same period.
  
  
  METHODS
  Primary outcome was in-hospital mortality.
  
  
  RESULTS
  The predicted death rate was 49 ± 26 for participants in the geriatric MU, 39.6 ± 27 for those in the medical MU (P = .02), and 36.7 ± 27 for those in the geriatric department (P < .001). Observed in-hospital mortality was higher for geriatric MU participants (n = 40, 44.9%) than for the department control group (n = 48, 27%) (P = .002), although the mortality ratios (actual divided by predicted death rates) of these two groups were similar, indicating that the more severely ill participants in the geriatric MU did better than control participants in the departments, in particular those requiring hemodynamic pressure support and those with acute renal failure.
  
  
  CONCLUSIONS
  For elderly, severely ill adults, care in a geriatric MU was associated with lower in-hospital mortality than care in the hospital geriatric ward and a longer stay and may be an alternative to medical MU admission.
authors.affiliation: Department of Geriatrics, Shaare Zedek Medical Center, affiliated with the Hadassah Medical School, Hebrew University, Jerusalem, Israel.
authors.forename: Abram
authors.initials: A
authors.lastname: Abramovitch
authors.affiliation: Department of Geriatrics, Shaare Zedek Medical Center, affiliated with the Hadassah Medical School, Hebrew University, Jerusalem, Israel.
authors.forename: Reuven
authors.initials: R
authors.lastname: Friedmann
authors.affiliation: Department of Medicine B, Shaare Zedek Medical Center, affiliated with the Hadassah Medical School, Hebrew University, Jerusalem, Israel.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Zevin
authors.affiliation: Department of Medicine C, Shaare Zedek Medical Center, affiliated with the Hadassah Medical School, Hebrew University, Jerusalem, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Munter
authors.affiliation: Division of Internal Medicine, Shaare Zedek Medical Center, affiliated with the Hadassah Medical School, Hebrew University, Jerusalem, Israel.
authors.forename: Amos M
authors.initials: AM
authors.lastname: Yinnon
authors.affiliation: Bioinformatics Unit, Shaare Zedek Medical Center, affiliated with the Hadassah Medical School, Hebrew University, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Raveh-Brawer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D016292:Procedural Sedation / Q000706:statistics & numerical data; D016638:Critical Illness / Q000628:therapy*; D004363:Drug Utilization; D005853:Geriatrics; D017052:Hospital Mortality; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D007557:Israel; D007902:Length of Stay; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D002316:Cardiotonic Agents
keywords: critical care; critically ill; elderly; geriatric department; intermediate care