Resultados asistenciales de las unidades geriátricas de agudos. Revisión sistemática

Background: the aim of this study was to perform a systematic review of the scientific information related to the results of in-hospital acute care for the elderly (ACE) units. Material and method: the search strategy included consultation of different bibliographic databases (MEDLINE, EMBASE, Dialnet and the Cochrane Central Register of Controlled Trials), review of the contents pages of five geriatric journals, and a retrospective search of the references in published articles. Results: forty-one articles with information on the results of ACE units were identified. Of these, only 21 met the inclusion criteria. These 21 articles provided data on 18 experiences in 19 hospitals. All the studies except one found a reduction in the mean length of stay in ACE units compared with conventional hospitalization. This reduction ranged from 30% to 54% in studies with historical samples, was more than 10% in hospital database studies, and ranged from 17% to 46% (P<.01) in case-control studies. Of 5 randomized controlled studies, 2 reported significant reductions in length of stay (19% and 24%, P<.01), another two studies reported trends in the same direction (3% and 12%) and 1 study found an increase in length of stay (32%) in the ACE unit. These studies reported tendencies towards reduced costs, lower institutionalization and functional improvement in patients admitted to ACE units. Conclusions: the studies performed to date show reductions in length of stay in elderly patients admitted to ACE units for acute illness compared with conventional hospitalization, leading to resource savings without decreasing the quality of care. The establishment of ACE units should be considered in hospitals without these units.