Effectiveness of interventions specifically targeting elderly patients
Systematic review
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Key message
Background
The number of elderly will increase over the coming years, due to the demographic development. Consequently, the need for hospital services that can meet the specific needs of elderly patients will also increase. Many old patients have several diseases, an impaired physical and cognitive level of functioning, and a weakened social network. Thus, this patient group represents a challenge for the hospitals and a review of the effectiveness of interventions specifically targeting this population is warranted.
Aim
The Western Norway Regional Health Authority (Helse Vest) has asked the Norwegian Knowledge Centre for the Health Services to assess whether geriatric evaluation and management of elderly inpatients leads to improved outcomes compared to the provision of ordinary care.
Methods
This report is predominantly an overview over reviews, i.e. we have searched for, critically appraised, and summarised research from existing systematic reviews of relevant effectiveness studies. After comprehensive searches in four databases we included 13 systematic reviews. In addition, we describe and discuss a recent randomised controlled trial from Norway.
Results
The 13 included systematic reviews were published between 1993 and 2005, and they overlapped considerably in terms of included studies. The majority of studies have taken place in the USA, relatively few in Europe. Most reviews included studies of general multidisciplinary geriatric evaluation and management of elderly patients admitted to hospitals due to acute functional failure, compared to routine care, e.g. in a medical department.
The results have been categorised in two groups: 1) Geriatric evaluation and management in specialised units/departments in the hospital, and 2) Geriatric consultation services by a team or an individual towards departments in the hospital.
Studies of evaluation and management in specialised units showed a positive effect on survival and return to own home versus death or institutionalisation. For example, Ellis and Langhorne found that at the time of follow-up (3-12 months), four more patients would be alive, living in their home for every 100 who had received the intervention. The results were less convincing when mortality was considered alone.
For other important outcomes, such as level of functioning, need for hospitalisation, and length of stay, the findings were inconsistent. For geriatric consultation teams towards other hospital departments, no convincing effects were demonstrated.
Conclusions
This overview of systematic reviews has shown that geriatric evaluation and management of elderly patients in hospitals leads to positive effects with regards to the chance of surviving and returning to own home versus dying or being 5 institutionalised. For other outcomes the findings were inconsistent. Using multidisciplinary consultation teams in hospitals has not been shown to be effective.
Considering the expected increase in number of elderly citizens, more research is clearly needed to develop and evaluate new, potentially improved interventions and to identify criteria to identify the elderly patients who are most likely to gain from specialised geriatric management strategies.