A study led by York researchers has found that hospitalized seniors fare better – have fewer falls, less functional decline at discharge and shorter stays – in acute geriatric care units where staff have a function-focused approach to care.
The purpose of the research was to determine the effectiveness of care for seniors in the acute phase of illness or injury admitted to acute geriatric units compared to seniors not admitted to these specialized centres.
“It is the first study to quantify the effectiveness of an innovative function-focused approach to older adults’ acute hospital care,” says York Professor Mary Fox of the graduate program in nursing in York’s School of Nursing, Faculty of Health. She is the first author of the article, “Effectiveness of Acute Geriatric Unit Care using ACE Components: A Systematic Review and Meta-Analysis”, published online Friday in the Journal of the American Geriatrics Society. It will also be published in an upcoming print version of the journal.
As the principal investigator of the Canadian Institutes of Health Research-funded study, Fox conducted a systematic review and meta-analysis of 13 trials involving 6,839 acutely ill or injured octogenarians. Acute geriatric units are those with at least one Acute Care for Elders (ACE) component, either patient-centred care, frequent medical review, early rehabilitation, early discharge planning or prepared environment. The goal of ACE components is to prevent hospital-acquired complications and functional deterioration associated with common hospital medications, treatments and procedures for older adults.
The researchers also found that seniors admitted to acute geriatric units had less delirium and were more likely to be discharged home as opposed to a nursing facility.
“It demonstrated that this approach has significant beneficial effects in improving both patient- and system-level outcomes over usual care,” says Fox. “Hospital administrators may anticipate cost savings of approximately $246 per person, per length of hospital stay (in US dollars, standardized to year 2000) and a reduced length of hospital stay by more than half a day, when compared to usual care.”
Seniors aged 65 and older are considered the “core business” of hospitals. They account for 40 per cent of all hospital care days even though they comprise only 14 per cent of the Canadian population.
“As older adults account for 50 per cent of Canadian hospital expenditures,” says Fox, “this cost difference may represent a significant future source of financial saving to Canada’s health-care system while improving patient outcomes.”
It is known that older adults face a higher risk of functional decline, falls, pressure ulcers and delirium when hospitalized, which is associated with increased hospital costs, institutionalization and death. “These poor outcomes are more often not related to their illness, but to other things, like not getting up and walking around while in the hospital or receiving treatments, such as drugs and catheters that make it difficult to move around. There are things that fall through the cracks,” says Fox. Early intervention is crucial in helping to circumvent these risks.
The goal is to develop senior-friendly hospitals by informing and engaging decision makers – clinicians, hospital administrators, policymakers and funders – about the best interventions to prevent physical, cognitive and psychosocial functional decline. Acute geriatric care units would not only save hospitals money, but provide the most beneficial care for seniors.
York nursing Professors Malini Persaud, Deborah Tregunno and Ellen Schraa, along with York librarian IIo-Katryn Maimets, were co-authors of the study, which included a team of researchers from York University and the University of Toronto.
The study was also supported by a York University Faculty of Health Junior Faculty award.
By Sandra McLean, YFile deputy editor