Effectiveness of gerontologically informed nursing assessment and referral interventions for older persons attending the emergency department: systematic review

Abstract

Title. Effectiveness of gerontologically informed nursing assessment and referral interventions for older persons attending the emergency department: systematic review. Aim. This paper is a report of a literature review conducted to analyse data from published studies reporting nursing interventions targeted at older attendees of emergency departments (EDs), and to provide a critical appraisal of the evidence concerning their effectiveness. Background. Attendance at hospital EDs by older persons presents opportunities for targeted interventions to address actual and potential problems associated with or in addition to the presenting problem. The evidence concerning the effectiveness of such interventions is mixed. Data sources. Studies were retrieved from a systematic search of published works indexed in CINAHL, MEDLINE (PubMed), Science Direct and the Cochrane Central Register of Controlled Trials (CENTRAL). Methods. A systematic review of effectiveness was conducted using the Cochrane Effective Practice and Organisation of Care guidelines and a narrative synthesis approach for data handling and presentation. The review period was 1992 to 31 August 2008. Results. Nursing assessment and referral interventions have demonstrated effectiveness in reducing service use and improving physical function, but have failed to demonstrate statistically significant effects on predicted patient and/or health systems outcomes. Conclusion. The evidence of the effectiveness of gerontologically informed nursing assessment and referral interventions in EDs must be accepted with caution, as not all studies demonstrated effectiveness in predicted patient and/or health systems outcomes, and the testing of complex social interventions in randomized clinical trials is inherently problematic. Further evidence of the effectiveness of nursing interventions is required, and such evidence might be usefully demonstrated using pragmatic, as opposed to explanatory, trials.

Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved

“…Another review of effectiveness of gerontologically informed nursing assessment and referral interventions for older people in the emergency department reported mixed results for patient and health systems outcomes. Here, too, the authors stressed that testing of complex interventions in RCTs was inherently problematic [52]. …”

Geriatric support in the emergency department: a national survey in Belgium

“…As a first step, screening tools could serve as “triggers” to identify the need for further geriatric assessment. Also, literature suggests that screening in the ED improves efficiency of geriatric interventions [30, 32–34]. Screening in ED could help in bed allocation for patients requiring hospitalisation, assigning the most vulnerable to geriatric evaluation and management units, where patient outcomes are better [35].…”

The impact of an emergency department nursing intervention on continuity of care, self-care capacities and psychological symptoms: Secondary outcomes of a randomized controlled trial

“…those factors that may influence emergency department utilisation. Systematic reviews of clinical emergency department-based interventions (Althaus et al, 2011;Fealy et al, 2009;McCusker and Verdon, 2006) have summarized the results of eight randomized controlled trials conducted in Canada (Gagnon et al, 1999;Lang et al, 2006;McCusker et al, 2003), United States (Mion et al, 2003;Shumway et al, 2008;Spillane et al, 1997), Australia (Caplan et al, 2004) and Sweden (Hansagi et al, 2008). Only one trial reported a significant impact on both secondary outcomes and revisits (Shumway et al, 2008).…”