| Some hospitals have specialized units to care for older, cognitively impaired patients, but whether such units improve outcomes is unclear. In this randomized trial, investigators compared care in a specialized unit versus standard care (geriatric or general medical wards) in 600 patients (median age, 85) identified as “confused” on admission to a large U.K. hospital. Specialized unit staff were skilled in managing patients with delirium and dementia, and specialized care included regular psychiatrist visits, organized activities, a physical environment tailored to patients with cognitive impairment, and proactive involvement of family caregivers.
After adjusting for multiple variables, investigators found no significant differences between patients randomized to specialized care and those randomized to standard care in days spent at home during 90 days after randomization (51 and 45 days) or in median length of hospital stay (11 days in both groups). Rates of return home from the hospital, in-hospital mortality, 90-day survival, hospital readmission, and nursing home placement also were similar. However, specialized-unit patients were significantly more likely than standard-care patients to be in a positive mood (79% vs. 68%), and their family caregivers were significantly more likely to be satisfied with their care (91% vs. 83%). COMMENTIn this trial, confused elders admitted to a specialized unit did not have superior healthcare-use outcomes or longer survival than those admitted to geriatric or general medical wards. Although patient mood and family caregivers’ satisfaction favored specialized care over standard care, the absolute differences were small. Based on these findings, justifying the costs associated with such specialized units would be difficult. |
Source: NEJM
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