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Review
. 2024 Feb 1;17(1):16.
doi: 10.1186/s12245-024-00584-7.

Strategies for improving ED-related outcomes of older adults who seek care in emergency departments: a systematic review

Ally Memedovich  1 , Benedicta Asante  1 , Maha Khan  1 , Nkiruka Eze  1 , Brian R Holroyd  2   3 , Eddy Lang  1   4   3   5 , Sherri Kashuba  3 , Fiona Clement  6   7
Affiliations
Review

Strategies for improving ED-related outcomes of older adults who seek care in emergency departments: a systematic review

Ally Memedovich et al. Int J Emerg Med. .

Abstract

Background: Despite constituting 14% of the general population, older adults make up almost a quarter of all emergency department (ED) visits. These visits often do not adequately address patient needs, with nearly 80% of older patients discharged from the ED carrying at least one unattended health concern. Many interventions have been implemented and tested in the ED to care for older adults, which have not been recently synthesized.

Methods: A systematic review was conducted to identify interventions initiated in the ED to address the needs of older adults. Embase, MEDLINE, CINAHL, Cochrane CENTRAL, the Cochrane Database of Systematic Reviews, and grey literature were searched from January 2013 to January 18, 2023. Comparative studies assessing interventions for older adults in the ED were included. The quality of controlled trials was assessed with the Cochrane risk-of-bias tool for randomized trials, and the quality of observational studies was assessed with the risk of bias in non-randomized studies of interventions tool. Due to heterogeneity, meta-analysis was not possible.

Results: Sixteen studies were included, assessing 12 different types of interventions. Overall study quality was low to moderate: 10 studies had a high risk of bias, 5 had a moderate risk of bias, and only 1 had a low risk of bias. Follow-up telephone calls, referrals, geriatric assessment, pharmacist-led interventions, physical therapy services, care plans, education, case management, home visits, care transition interventions, a geriatric ED, and care coordination were assessed, many of which were combined to create multi-faceted interventions. Care coordination with additional support and early assessment and intervention were the only two interventions that consistently reported improved outcomes. Most studies did not report significant improvements in ED revisits, hospitalization, time spent in the ED, costs, or outpatient utilization. Two studies reported on patient perspectives.

Conclusion: Few interventions demonstrate promise in reducing ED revisits for older adults, and this review identified significant gaps in understanding other outcomes, patient perspectives, and the effectiveness in addressing underlying health needs. This could suggest, therefore, that most revisits in this population are unavoidable manifestations of frailty and disease trajectory. Efforts to improve older patients' needs should focus on interventions initiated outside the ED.

Keywords: Emergency department; Frequent use; Older adults; Systematic review.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRIMSA diagram
Fig. 2
Fig. 2
Characteristics of included studies
Fig. 3
Fig. 3
Risk of bias for controlled trials
Fig. 4
Fig. 4
Risk of bias for observational studies
Fig. 5
Fig. 5
Effect of interventions for older adults. Legend: The interventions identified are across the x-axis, and the outcomes reported are on the y-axis. Each study is reported with one column of bubbles. The bubble size represents the size of the study
See this image and copyright information in PMC

References

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