Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: a systematic review and meta-analysis

Abstract

BackgroundOlder age and higher acuity are associated with prolonged hospital stays and hospital readmissions. Early discharge planning may reduce lengths of hospital stay and hospital readmissions; however, its effectiveness with acutely admitted older adults is unclear.MethodsIn this systematic review, we compared the effectiveness of early discharge planning to usual care in reducing index length of hospital stay, hospital readmissions, readmission length of hospital stay, and mortality; and increasing satisfaction with discharge planning and quality of life for older adults admitted to hospital with an acute illness or injury.We searched the Cochrane Library, DARE, HTA, NHSEED, ACP, MEDLINE, EMBASE, CINAHL, Proquest Dissertations and Theses, PubMed, Web of Science, SciSearch, PEDro, Sigma Theta Tau International’s registry of nursing research, Joanna Briggs Institute, CRISP, OT Seeker, and several internet search engines. Hand-searching was conducted in four gerontological journals and references of all included studies and previous systematic reviews. Two reviewers independently extracted data and assessed risk of bias. Data were pooled using a random-effects meta-analysis. Where meta-analysis was not possible, narrative analysis was performed.ResultsNine trials with a total of 1736 participants were included. Compared to usual care, early discharge planning was associated with fewer hospital readmissions within one to twelve months of index hospital discharge [risk ratio (RR) = 0.78, 95% CI = 0.69 − 0.90]; and lower readmission lengths of hospital stay within three to twelve months of index hospital discharge [weighted mean difference (WMD) = −2.47, 95% confidence intervals (CI) = −4.13 − −0.81)]. No differences were found in index length of hospital stay, mortality or satisfaction with discharge planning. Narrative analysis of four studies indicated that early discharge planning was associated with greater overall quality of life and the general health domain of quality of life two weeks after index hospital discharge.ConclusionsEarly discharge planning with acutely admitted older adults improves system level outcomes after index hospital discharge. Service providers can use these findings to design and implement early discharge planning for older adults admitted to hospital with an acute illness or injury.

Use of a functional mobility measure to predict discharge destinations for patients admitted to an older adult rehabilitation ward: A feasibility study

“…For the rehabilitation team, knowing likely discharge destination facilitates referral for assessment for carers or residential placement, and for the patient going home, enables timely organising of required compensatory equipment. In addition to the practical benefits of the early planning of discharge, the literature demonstrates considerable quality of life and health economic benefits, with a sustainable discharge leading to a reduction in hospital readmission, length of hospital readmission stay and all‐cause mortality 6, 8.…”

“…Early discharge planning for the older adult has been shown to reduce hospital readmissions, duration of hospital readmissions and all‐cause mortality, and to improve quality of life 6, 7, 8. Recent systematic reviews identified many social, physical and cognitive factors that predict discharge destination for stroke 9 and non‐stroke patients 10.…”

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“…the possessed skills (Fox et al, 2013). Mari et al (2013) indicated self-efficacy as individual ability to engage in certain work and the subjective evaluation of the work being done.…”