The Effectiveness of Inpatient Geriatric Evaluation and Management Units: A Systematic Review and Meta‐Analysis

Abstract

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU. DESIGN: Systematic review and meta‐analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors. SETTING: GEMUs. PARTICIPANTS: Elderly people admitted to a GEMU. MEASUREMENTS: Quality of the studies was assessed on 10 criteria. The outcome parameters were mortality, institutionalization, functional decline, readmission, and length of stay at different follow‐up points. A random‐effects meta‐analysis was performed using Hedges' gu and variance of relative risk (RR). RESULTS: GEMUs are organized in a heterogeneous way and the included studies gave no thorough description of comprehensive geriatric assessment (CGA). Involvement of a multidisciplinary team was a key element in all GEMUs. The individual trials showed that admission to a GEMU has one or more favorable effects on the outcomes of interest, with two significant effects in the meta‐analysis: less functional decline at discharge from the GEMU (RR=0.87, 95% confidence interval (CI)=0.77–0.99; P =.04) and a lower rate of institutionalization 1 year after discharge (RR=0.78, CI=0.66–0.92; P =.003). For the other outcomes in the meta‐analysis, a GEMU did not induce significantly different outcomes than usual care. CONCLUSION: This meta‐analysis shows a significant effect in favor of the GEMU group on functional decline at discharge and on institutionalization after 1 year. There is heterogeneity between the studies, poor quality of some randomized controlled trials, and shortage of information about CGA. Multidisciplinary CGA offered in a GEMU may add value to the care for frail older persons admitted to the hospital, but the limitations confirm the need for well‐designed studies using explicit CGA and more‐structured and ‐coherent assessment instruments such as the Minimum Data Set Resident Assessment Instrument.