Effectiveness of an Acute Care for Elders unit at a long-term care facility for frail older patients with COVID-19.
Gabriel Vallecillo, Marta Anguera, Noemi Martin and 1 others
PMID 33139081WHAT IT FOUND
In 51 frail older patients with COVID-19 in a confined long-term care unit, 36 had no Barthel change at discharge and 15 had changes with a median of 10 points.
This uncontrolled study cannot show the nurse-driven ACE bundle prevented decline.
Key findings
01Among 51 included patients, 36 had no change in Barthel Index score at discharge and 15 had changes with a median of 10 points (range 5-20).
02Delirium developed in 17 patients (33.3%), and other geriatric syndromes in 4 (7.8%), including pressure ulcer in 2 and falls in 2.
03Four patients (7.8%) died during the first month post-COVID-19 diagnosis, and six (11.7%) were transferred to acute hospital.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no control group of usual care, so the study cannot show that the ACE unit reduced functional decline, delirium, transfers or deaths. Only 51 patients were analysed, and the study was conducted in one confined unit, so the findings are descriptive. Patients who were asymptomatic or already totally dependent were excluded, so it does not describe all frail older adults with COVID-19. The nurses were volunteers with geriatric training, and family visits were restricted, so the care may not be feasible in ordinary units. The intervention was a bundle of nursing, assistant, social work, and medical care, so the effect of any single component cannot be separated.
The easy way to misread this
Do not read the 36 patients with no Barthel change as proof that the ACE unit prevented hospital-associated disability. The study had no control group, and 15 patients had Barthel changes, so it cannot show what would have happened without the unit.