End-of-life care for older people in the emergency department: a scoping review

Article

Huang, Ya-Ling, Alsaba, Nemat, Brookes, Gemma and Crilly, Julia. 2020. "End-of-life care for older people in the emergency department: a scoping review." Emergency Medicine Australasia. 32 (1), pp. 7-19. https://doi.org/10.1111/1742-6723.13414
Article Title

End-of-life care for older people in the emergency department: a scoping review

ERA Journal ID16047
Article CategoryArticle
AuthorsHuang, Ya-Ling, Alsaba, Nemat, Brookes, Gemma and Crilly, Julia
Journal TitleEmergency Medicine Australasia
Journal Citation32 (1), pp. 7-19
Number of Pages13
Year2020
PublisherJohn Wiley & Sons
Place of PublicationAustralia
ISSN1742-6723
1742-6731
Digital Object Identifier (DOI)https://doi.org/10.1111/1742-6723.13414
Web Address (URL)https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.13414
Abstract

Older people are increasingly utilising emergency services, often at the end of their life. This scoping review aimed to provide a comprehensive understanding of available research regarding end-of-life (EOL) care for older people in the ED. The Joanna Briggs Institute scoping review methodology guided this review. Databases of CINAHL, Ovid MEDLINE, Embase, SocINDEX and Google Scholar were searched using a combination of terms, including older/aged/geriatrics/elderly, palliative/terminal/end-of-life and emergency/emergency service. The search was limited to articles published in English from 2007 to 2018. The level of evidence of included articles was assessed using the National Health and Medical Research Council (NHMRC) criteria. Fourteen articles were included. Definitions pertaining to EOL care in the ED vary. Older people presenting to ED at EOL were mostly female, triaged in urgent or semi-urgent category, presented with diagnoses of advanced cancer, cardiac and pulmonary disease, and dementia with symptoms including pain and breathlessness. Multiple tools pertaining to EOL exist and range from predicting mortality, and assessing functional status, co-morbidities, symptom distress, palliative care needs, quality of life and caregiver's stress. Outcomes for older people enrolled in specific EOL intervention programmes included lower admission rates, shorter ED length of stay, increased palliative care referral and consultations, and decreased Medicare costs. The NHMRC evidence level of included articles ranged from II to IV. Limited evidence exists regarding the definition, clinical profile, care delivery and outcomes for older people requiring EOL care in the ED. Future research and clinical practice that uses current evidenced-based policies and guidelines is required.

Keywordsaged; emergency service; hospital; palliative care; review; terminal care
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020420501. Acute care
420316. Palliative care
420312. Implementation science and evaluation
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Byline AffiliationsGold Coast Hospital and Health Service, Australia
Griffith University
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