Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

Article


Fan, Lijun, Lukin, William, Zhao, Jingzhou, Sun, Jiandong and Hou, Xiang-Yu. 2015. "Interventions targeting the elderly population to reduce emergency department utilisation: a literature review." Emergency Medicine Journal. 32 (9), pp. 738-743. https://doi.org/10.1136/emermed-2014-203770
Article Title

Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

ERA Journal ID16048
Article CategoryArticle
AuthorsFan, Lijun (Author), Lukin, William (Author), Zhao, Jingzhou (Author), Sun, Jiandong (Author) and Hou, Xiang-Yu (Author)
Journal TitleEmergency Medicine Journal
Journal Citation32 (9), pp. 738-743
Number of Pages6
Year2015
Place of PublicationUnited Kingdom
ISSN1472-0205
1472-0213
Digital Object Identifier (DOI)https://doi.org/10.1136/emermed-2014-203770
Web Address (URL)https://emj.bmj.com/content/32/9/738
Abstract

Objective High utilisation of emergency department (ED) among the elderly is of worldwide concern. This study aims to review the effectiveness of interventions targeting the elderly population in reducing ED utilisation.

Methods Major biomedical databases were searched for relevant studies. Qualitative approach was applied to derive common themes in the myriad interventions and to critically assess the variations influencing interventions’ effectiveness. Quality of studies was appraised using the Effective Public Health Practice Project (EPPHP) tool.

Results 36 studies were included. Nine of 16 community-based interventions reported significant reductions in ED utilisation. Five of 20 hospital-based interventions proved effective while another four demonstrated failure. Seven key elements were identified. Ten of 14 interventions associated with significant reduction on ED use integrated at least three of the seven elements. All four interventions with significant negative results lacked five or more of the seven elements. Some key elements including multidisciplinary team, integrated primary care and social care often existed in effective interventions, while were absent in all significantly ineffective ones.

Conclusions The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.

Keywordsemergency department; emergency medicine; elderly; intervention; overcrowded
ANZSRC Field of Research 2020320207. Emergency medicine
420306. Health care administration
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Byline AffiliationsQueensland University of Technology
Department of Health, Queensland
China Investment Promotion Agency, China
Institution of OriginUniversity of Southern Queensland
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