Efficacy of emergency department‐based interventions designed to reduce repeat visits and other adverse outcomes for older patients after discharge: A systematic review

Abstract

AimThere is an urgent need for effective geriatric interventions to meet the health service demands of the growing older population. In this paper, we systematically review and update existing literature on interventions within emergency departments (ED) targeted towards reducing ED re‐visits, hospitalizations, nursing home admissions and deaths in older patients after initial ED discharge.Methods Databases Medline, CINAHL, Embase and Web of Science were searched to identify all articles published up to June 2012 that focused on older adults in the ED, included a comparison group, and reported quantitative results in four primary outcomes: ED re‐visits, hospitalizations, nursing home admissions and death after initial ED discharge.ResultsOf the 2826 titles screened, just nine studies met our inclusion criteria. The studies varied in their design and outcome measurements such that results could not be combined. Two trends surfaced: (i) more intensive interventions more frequently resulted in reduced adverse outcomes than did simple referral intervention types; and (ii) among the lowest intensity, referral‐based interventions, studies that used a validated prediction tool to identify high‐risk patients more frequently reported improved outcomes than those that did not use such a tool.ConclusionOf the few studies that met the inclusion criteria, there was a lack of consistency and clarity in study designs and evaluative outcomes. Despite this, more intensive interventions that followed patients beyond a referral and the use of a clinical risk prediction tool appeared to be associated with improved outcomes. The dearth of rigorous evaluations with standardized methodologies precludes further recommendations. Geriatr Gerontol Int 2015; 15: 1107–1117.

Emergency Department Interventions for Older Adults: A Systematic Review

“…Across these reviews, general themes are that more comprehensive interventions and those using multiple strategies are associated with greater effects but that interventions tested to date do not show a consistent effect on utilization outcomes. Similar to previous reviews and the 2014 Geriatric Emergency Department Guidelines, our finding that bridge designs may be associated with positive outcomes suggests that ED visits should not be considered in isolation but rather as an integral part of the older patient's continuum of care, bridging inpatient and outpatient services.…”

Characteristics of fall‐related traumatic brain injury in older adults

“…In addition to demographics data, weighted Charlson Comorbidity Index, fall circumstances, high‐risk medications, blood pressure reading on presentation, mortality and length of stay were also obtained. As prior falls is a known risk factor for future falls, ED visits 12 months and hospitalisations 3 months before index admission, specifically if they were falls‐related, were also recorded. Other outcome measures included readmissions within 1 year post‐discharge, functional status on discharge and specialist outpatient clinic utilisation before and after FRTBI.…”

Factors associated with hospital admission after an emergency department treat and release visit for older adults with injuries

“…Identifying patients at high risk of inpatient admission could be useful in creating policies for treating these patients while they are in the ED and for targeting prevention efforts for after they are discharged home. Several prevention efforts have been proposed, and those that go beyond a simple referral or that use a clinical prediction tool to identify eligible patients seem to be associated with the best outcomes [17]. About half (46.3%) of the patients who required inpatient admission within 9 days were diagnosed with a new injury at the time of admission.…”