Emergency Department Interventions for Older Adults: A Systematic Review

Abstract

OBJECTIVES To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults. DESIGN A conceptual model informed, protocol‐based systematic review. SETTING Emergency Department (ED). PARTICIPANTS Older adults 65 years of age and older. METHODS AND MEASUREMENT Medline, Embase, CINAHL, and PsycINFO were searched for English‐language studies published through December 2017. Studies evaluating the use of one or more eligible intervention strategies (discharge planning, case management, medication safety or management, and geriatric EDs including those that cited the 2014 Geriatric ED Guidelines) with adults 65 years of age and older were included. Studies were classified by the number of intervention strategies used (ie, single strategy or multi‐strategy) and key intervention components present (ie, assessment, referral plus follow‐up, and contact both before and after ED discharge [“bridge”]). The effect of ED interventions on clinical (functional status, quality of life [QOL]), patient experience, and utilization (hospitalization, ED return visit) outcomes was evaluated. RESULTS A total of 2000 citations were identified; 17 articles describing 15 unique studies (9 randomized and 6 nonrandomized) met eligibility criteria and were included in analyses. ED interventions showed a mixed pattern of effects. Overall, there was a small positive effect of ED interventions on functional status but no effects on QOL, patient experience, hospitalization at or after the initial ED index visit, or ED return visit. CONCLUSION Studies using two or more intervention strategies may be associated with the greatest effects on clinical and utilization outcomes. More comprehensive interventions, defined as those with all three key intervention components present, may be associated with some positive outcomes.

A qualitative study of old patients’ experiences of the quality of the health services in hospital and 30 days after hospitalization

“…This study in line with other research, shows that further work must be done to ensure coverage of integrated services without a financial burden, centered on the needs and rights of older people [54].…”

“…Our patients reported reduced capacity with little capability to engage in daily tasks and decisions concerning their own health. The decision-making capacity of older patients may be limited owing to cognitive decline, emotional distress, multiple chronic conditions or a combination of these[54]. Shared decisionmaking with older patients who are frail requires a continuous counselling dialogue[55] adapted to each patient's capacity.…”

A qualitative study of old patients’ experiences of the quality of the health services in hospital and 30 days after hospitalization

“…This study in line with other research, shows that further work must be done to ensure coverage of integrated services without a financial burden, centered on the needs and rights of older people [54]. Healthcare quality for elderly people demands a healthcare system organized in ways that ensure care and support consistent with their basic rights, fundamental freedoms and human dignity.…”

“…Our patients reported reduced capacity with little capability to engage in daily tasks and decisions concerning their own health. The decision-making capacity of older patients may be limited owing to cognitive decline, emotional distress, multiple chronic conditions or a combination of these [54]. Shared decision-making with older patients who are frail requires a continuous counselling dialogue [55] adapted to each patient's capacity.…”

Effect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non‐randomised trial

“…If admitted, RACF residents suffer high rates of iatrogenic hospital acquired complications such as falls, urosepsis and delirium . Systematic reviews of studies on admission avoidance strategies and ED interventions for older adults have highlighted a lack of evidence, related to the optimal model of care in ED, especially for patients presenting from RACFs . The aim of the present study was to evaluate the effectiveness of the Geriatric Emergency Department Intervention (GEDI) model on the primary outcomes of disposition (admission, discharge or death) and ED LoS for residents of RACFs, presenting to an ED in regional Queensland, Australia.…”