Volume 58, Issue 1 p. 83-92

The Effectiveness of Inpatient Geriatric Evaluation and Management Units: A Systematic Review and Meta-Analysis

Katleen Van Craen RN, MSc

Katleen Van Craen RN, MSc

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Tom Braes RN, PhDcand

Tom Braes RN, PhDcand

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Nathalie Wellens SLP, PhDcand

Nathalie Wellens SLP, PhDcand

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Kris Denhaerynck RN, PhD

Kris Denhaerynck RN, PhD

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Johan Flamaing MD, PhD

Johan Flamaing MD, PhD

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Philip Moons RN, PhD

Philip Moons RN, PhD

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Steven Boonen MD, PhD

Steven Boonen MD, PhD

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Christiane Gosset MD, PhD

Christiane Gosset MD, PhD

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Jean Petermans MD, PhD

Jean Petermans MD, PhD

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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Koen Milisen RN, PhD

Koen Milisen RN, PhD

From the * Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium; Rehabilitation Hospital Hof ter Schelde, Antwerp, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium; § Department of Internal Medicine, University Hospital Basel, Basel, Switzerland; Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; and Departments of # Public Health Sciences and ** Geriatric Medicine, University of Liège, Liège, Belgium.

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First published: 04 January 2010
Citations: 164
Address correspondence to Koen Milisen, Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium. E-mail: [email protected]

Abstract

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU.

DESIGN: Systematic review and meta-analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors.

SETTING: GEMUs.

PARTICIPANTS: Elderly people admitted to a GEMU.

MEASUREMENTS: 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.

CONCLUSION: 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.