Twenty-six studies.
Acute geriatric units (n=4 studies, 3 RCTs).
No significant differences in mortality or rates of institutionalisation. Functional improvement and fewer nursing home transfers were seen in one trial, but these were not maintained beyond three months.
Post-acute geriatric evaluation and management (GEM).
1. Hospital based GEM (n = 3 RCTs and 1 systematic review).
Inpatient GEM units, which focus on rehabilitation and restoration of independent functioning, improve mortality, functional outcomes and discharge to home. A recent meta analysis (see Other Publications of Related Interest no.1) based on 28 controlled trials and 9871 patients evaluated inpatient GEM units, inpatient consultation services, outpatient geriatric consultation services and home assessment for discharged patients. Outcomes were mortality at one year, living at home at one year and physical function improvement at one year.
2. Community or home-based GEM (n = 3 RCTs).
Rehabilitation provided by geriatric teams in the community or home to recently discharged patients with specific syndromes facilitate earlier hospital discharge.
Geriatric consultation services (n = 11 RCTs).
Inconsistent results from trials for outcomes such as improvement of functional measures, reduced nursing home transfers and lower mortality.
Geriatric day hospitals (n = 1 RCT).
Limited randomised evidence based on small patient numbers suggest day hospitals, to which patients recently discharged from acute wards are referred for GEM, have minimal impact.
Condition-specific interventions (n = 4 RCTs). As an alternative to GEM based on age or fragility criteria, geriatric interventions may be better targeted at specific clinical syndromes associated with significant mortality and burden of illness.