The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

Abstract

Background Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults following presentation to the ED. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED. Methods Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and the PROSPERO register up until June 2020. Grey literature was also searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed using a matrix of evidence table. An algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied for all outcomes. Results Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate. Results were presented narratively and summary of evidence tables created. Conclusion Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The existing evidence for the effectiveness of ED interventions for older adults is limited. This umbrella review highlights the challenge of synthesising evidence due to significant heterogeneity in methods, intervention content and reporting of outcomes. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended, rather than the publication of further systematic reviews. Trial registration UMBRELLA REVIEW REGISTRATION: PROSPERO (CRD42020145315).

Effectiveness of interventions to address different types of vulnerabilities in community‐dwelling older adults: An umbrella review

“…The quality of the reviews ranged from low to critically low which is comparable to other assessments of reviews of interventions addressing geriatric care (Conneely et al, 2022 ; Lozano‐Montoya et al, 2017 ). Furthermore, several evidence gaps within the reviews have also become apparent such as: effects of multi‐component interventions focused on older adults with multiple vulnerabilities, effects of community‐focused interventions adapted to local needs, or interventions that impacted client‐centered outcomes.…”

“…The quality of the reviews ranged from low to critically low which is comparable to other assessments of reviews of interventions addressing geriatric care (Conneely et al, 2022;Lozano-Montoya et al, 2017). Furthermore, several evidence gaps within the reviews have also become apparent such as: effects of multi-component et al, 2018).…”

Lost in transition? Community residential facility staff and stakeholder perspectives on previously incarcerated older adults’ transitions into long-term care

“…In particular, transitional care scholars contend that poor communication [ 3 ], inadequate medication reconciliation [ 4 ] and a lack of patient follow-ups between services [ 5 ] impede the transitional care provided to older adults. These deficits in care have an adverse impact on older patients which has resulted in increased rates of infection, falls and medication errors during transitions in care [ 6 , 7 ].…”

Geriatric emergency medicine: Complexity evolves with age

“…5 With almost one-third of older adults experiencing an adverse outcome within 3 months of their ED presentation, the balance between rationalising investigations, admission, safe discharge and community care, presents challenges in order to prevent functional decline, unplanned hospital admissions, transition to long-term care facilities and ED representations. 6,7 There is a paradigm shift underway with shared-care models, a focus on frailty syndrome management, and the promotion of community care that is redefining the role of geriatric emergency medicine (GEM) in order to adequately respond to the often-complex needs of this growing ED cohort. 8…”

“…The growing demand for geriatric care and increasing ED presentations has been identified as one of the key leadership challenges for directors of emergency medicine 5 . With almost one‐third of older adults experiencing an adverse outcome within 3 months of their ED presentation, the balance between rationalising investigations, admission, safe discharge and community care, presents challenges in order to prevent functional decline, unplanned hospital admissions, transition to long‐term care facilities and ED representations 6,7 …”