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Improving outcomes for older people in the emergency department: a review of reviews
  1. Louise Preston1,
  2. James David van Oppen2,3,
  3. Simon Paul Conroy2,
  4. Suzanne Ablard1,
  5. Helen Buckley Woods4,
  6. Suzanne M Mason1
  1. 1School of Health and Related Research, The University of Sheffield, Sheffield, UK
  2. 2Department of Health Sciences, University of Leicester, Leicester, UK
  3. 3Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
  4. 4Information School, The University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Louise Preston, School of Health and Related Research, The University of Sheffield, Sheffield S10 2TN, UK; l.r.preston{at}sheffield.ac.uk

Abstract

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.

  • emergency care systems
  • emergency departments
  • geriatrics
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Footnotes

  • Handling editor Mary Dawood

  • Twitter @LouisePreston13, @J_vanOppen, @ProfSueMason

  • Contributors SPC and SMM conceptualised the study, SPC, SMM and LP obtained research funding for the study. LP, SPC, SMM, JDvO, SA and HW developed the protocol. HW ran the literature searches. LP, SA, SPC and JDvO undertook screening of the included studies, data extraction and quality assessment. LP drafted the manuscript and all authors contributed.

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

  • Disclaimer The views expressed are those of the author(s) and not necessarily of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval No ethical approval was required for this review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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