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

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

Emergency department, Frequent use, Older adults, Systematic review

Background Despite constituting 14% of the general population, older adults make up almost a quarter of all emer-
gency 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-rand-
omized 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 identi-
fied 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 manifes-
tations of frailty and disease trajectory. Efforts to improve older patients’ needs should focus on interventions initiated

outside the ED.

Ally Memedovich1

, Benedicta Asante1

, Maha Khan1

, Nkiruka Eze1

, Brian R. Holroyd2,4, Eddy Lang1,3,4,5,

Sherri Kashuba4 and Fiona Clement1,5*

https://doi.org/10.1186/s12245-024-00584-7

2024

Peri Irawan

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