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Improving outcomes for older people in the emergency department: A review of reviews

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journal contribution
posted on 27.11.2020, 17:22 by L Preston, JD Van Oppen, SP Conroy, S Ablard, H Buckley Woods, SM Mason
Background: There has been a recognised trend of increasing use of emergency and urgent care and emergency departments (EDs) by older people, which is marked by a substantial evidence base reporting interventions for this population and guidance from key organisations. Despite this, outcomes for this population remain suboptimal. A plethora of reviews in this area provides challenges for clinicians and commissioners in determining which interventions and models of care best meet people's needs. The aim of this review was to identify effective ED interventions which have been reported for older people, and to provide a clear summary of the myriad reviews and numerous intervention types in this area. Methods: A review of reviews, reporting interventions for older people, either initiated or wholly delivered within the ED. Results: A total of 15 review articles describing 83 primary studies met our content and reporting standards criteria. The majority (n=13) were systematic reviews (four using meta-analysis.) Across the reviews, 26 different outcomes were reported with inconsistency. Follow-up duration varied within and across the reviews. Based on how authors had reported results, evidence clusters were developed: (1) staff-focused reviews, (2) discharge intervention reviews, (3) population-focused reviews and (4) intervention component reviews. Conclusions: The evidence base describing interventions is weak due to inconsistent reporting, differing emphasis placed on the key characteristics of primary studies (staff, location and outcome) by review authors and varying quality of reviews. No individual interventions have been found to be more promising, but interventions initiated in the ED and continued into other settings have tended to result in more favourable patient and health service outcomes. Despite many interventions reported within the reviews being holistic and patient focused, outcomes measured were largely service focused. PROSPERO registration number: PROSPERO CRD42018111461.

Funding

This research was funded by the National Institute for Health Research, Health Services and Delivery Research - 17/05/96, £931,653.

History

Citation

Emergency Medicine Journal Published Online First: 26 October 2020. doi: 10.1136/emermed-2020-209514

Author affiliation

Department of Health Sciences, University of Leicester

Version

AM (Accepted Manuscript)

Published in

Emergency Medicine Journal

Publisher

BMJ Publishing Group for College of Emergency Medicine

issn

1472-0205

eissn

1472-0213

Acceptance date

26/08/2020

Copyright date

2020

Available date

06/04/2021

Spatial coverage

England

Language

eng

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