Specialized Geriatric Hospital Units Aid Elderly
Older people cared for in specialized geriatric hospital units tend to decline at a slower pace than those given conventional hospital care, recent research suggests.
Aging brings a certain amount of natural deterioration in cognitive performance, which can interfere with normal activities. However, in previous studies, a more powerful indicator of poor medical outcomes is “functional decline.”
Functional decline has been defined as “a reduced ability to perform tasks of everyday living, for example, walking or dressing, due to a decrement in physical or cognitive functioning.” Up to half of geriatric patients have either loss of or reduced ability in at least one activity of daily living. The decline can begin as early as the second day in hospital.
Dr. Leocadio Rodriguez-Manas and colleagues from Getafe Universitary Hospital in Madrid say that hospital care for people over 65 years old requires “a thorough assessment to assess the risk of functional decline,” which they state is the main determinant of quality of life, cost of care, and prognosis.
Delaying such decline and helping patients return home are at least as important as reducing mortality, the researchers believe. They analyzed 11 studies on the outcomes of specialized acute geriatric units compared with conventional hospital care. Patients were at least 65 years of age and had medical problems which did not necessitate treatment in other specialized units.
There was an 18 percent lower risk of functional decline at discharge, and in the next three months, following care in a specialized unit. The patients were more likely to remain mobile and be able to carry out usual daily activities. They also had a 30 percent higher chance of returning home after leaving the hospital. There was no difference in mortality rates or cost of care between the two groups.
Each of the individual studies showed similar results, the team reports on the website of the British Medical Journal: “Since admission to hospital is a risk factor for case fatality, functional decline, and admission to a nursing home, any intervention that helps reduce this risk is potentially important.”
They add that the 18 percent reduction in functional decline associated with specialized geriatric units is similar to that found in an earlier study of similar patients who received multidisciplinary care. Future studies should examine whether the reduction in functional decline persists in the medium-term after discharge, they write. Ideally, more patients would be involved, and they would be randomly allocated to standard or specialist care.