The impact of community nurse‐led interventions on the need for hospital use among older adults: An integrative review

Abstract

Background Hospital avoidance services are important for older people who risk deteriorating health and independence when in hospital. However, the evidence base for nurse‐led community services is equivocal. Objectives To determine the impact of community nurse‐led interventions on the need for hospital use among older adults. Methods The integrative review method of Whittemore and Knafl was employed and reported in accordance with PRIMSA guidelines. Medline, EMBASE and CINAHL were searched from January 2011 to January 2019. Outcomes were coded and findings reported by outcome domain to provide an integrated, narrative synthesis. Results Nine studies were included in the review. Whilst disparities in the evidence base persist, specialist high‐intensity, team‐based hospital‐at‐home services were significantly more likely to reduce hospital admissions than standard care. An individual case management services that incorporated self‐help education for chronic disease management also reduced hospital admissions. Financial data suggest that whilst high‐intensity services are costly, they can lead to significant efficiency savings in the longer‐term. Conclusion This topic remains an important area for further investment, managerial support and research because of the risks faced by older people when admitted to hospital, for whom health, quality of life and independence are vital considerations. Implications for practice The provision of high‐intensity team‐based services and self‐help education can optimise health outcomes and reduce the need for hospital use among older adults living in the community.

Effects of a Nurse-Led Telehealth Self-care Promotion Program on the Quality of Life of Community-Dwelling Older Adults: Systematic Review and Meta-analysis

“…In previous studies evaluating the effects of nurse-led programs of care, the findings regarding hospital admissions were mixed. A recent integrative review that included 9 studies concluded that there is no clear evidence that community nurse–led services for older persons reduced hospital readmissions [ 40 ]. A similar finding was reported by studies involving other patient groups such as children discharged from hospital [ 41 ] and persons with heart failure [ 42 ].…”

How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review

“…This may sound simple; however, further research is required to ensure that determining complexity and the subsequent decision making to provide better care. With the focus of aged care shifting to increasing the support provided at home (Dunn et al, 2021; Royal Commission, 2021; Veldhuizen et al, 2021), it is timely for research into complexity, how to measure and detect complexity and how subsequent decisions are made to support people to remain at home.…”

“…The impact of these factors varies, with some people responding to medication or other management, while others do not (Jamerson et al, 2016). Additionally, changes in healthcare strategy, including early hospital discharge and improved chronic disease treatments, necessitate new assessment processes that consider the older person's preferences (Dunn et al, 2021; Frost et al, 2020; Lyndon et al, 2021).…”

Custo direto de internações hospitalares por doenças crônicas não transmissíveis sensíveis à atenção primária em idosos

“…Tais achados demonstram que além de gerar um forte impacto orçamentário para o sistema de saúde, as internações de pacientes idosos também geram consequências diretas para a saúde do próprio indivíduo, e impactam negativamente tanto na sua funcionalidade e qualidade de vida, quanto a dos seus cuidadores 23 . Como alternativa, no estudo de Dunn et al 24 , o investimento em programas de cuidados domiciliares com estímulo ao autocuidado em saúde gerou uma redução direta dos custos com internações hospitalares. Além disso, é importante que esse paciente tenha um planejamento de alta adequado e que busque identificar as necessidades após a alta para proporcionar meios de acesso para suportes que serão necessários, evitando, assim, as readmissões hospitalares em curto período de tempo 23 .…”