Review article: End‐of‐life care for older people in the emergency department: A scoping review

Huang, Ya‐Ling; Alsaba, Nemat; Brookes, Gemma; Crilly, Julia

doi:10.1111/1742-6723.13414

Cited by 17 publications

(13 citation statements)

References 27 publications

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“…The Acute Frailty network in the UK is an example of a whole systems approach for older people admitted to hospital and has shown improvement in patient outcomes [ 98 ]. A research priority identified by the European Society for Emergency Medicine Geriatric Emergency Medicine [ 4 ] section and the European Geriatric Medicine Society GEM Special Interest Group is to identify if elements of CGA are effective in improving outcomes for older patients [ 83 ]. Other key research questions included what community interventions are safe and effective to prevent adverse outcomes for older adults following discharge from the ED.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

et al. 2022

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Background Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults following presentation to the ED. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED. Methods Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and the PROSPERO register up until June 2020. Grey literature was also searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed using a matrix of evidence table. An algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied for all outcomes. Results Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate. Results were presented narratively and summary of evidence tables created. Conclusion Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The existing evidence for the effectiveness of ED interventions for older adults is limited. This umbrella review highlights the challenge of synthesising evidence due to significant heterogeneity in methods, intervention content and reporting of outcomes. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended, rather than the publication of further systematic reviews. Trial registration UMBRELLA REVIEW REGISTRATION: PROSPERO (CRD42020145315).

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Section: Discussionmentioning

confidence: 99%

The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

et al. 2022

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“…There is general consensus that delivering high-quality end-of-life care in the ED is an unmet need. 14 Compared with dying at home or in a hospice facility, quality of dying in the hospital is worse and may lead to protracted grief and psychological distress for families. 4 Time constraints, patient volume, and environmental factors may contribute to suboptimal patient care and family experience.…”

Section: Discussionmentioning

confidence: 99%

Death and End-of-Life Care in Emergency Departments in the US

et al. 2022

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ImportanceThere are more than 140 million annual visits to emergency departments (EDs) in the US. The role of EDs in providing care at or near the end of life is not well characterized.ObjectiveTo determine the frequency of death in the ED or within 1 month of an ED visit in an all-age, all-payer national database.Design, Setting, and ParticipantsThe retrospective cohort study used patient-level data from the nationally representative Optum clinical electronic health record data set for 2010 to 2020. Data were analyzed from January to March 2022.ExposuresAge, Charlson Comorbidity Index (CCI), and year of ED encounter.Main Outcomes and MeasuresThe primary outcome was death in the ED, overall and stratified by age, CCI, or year. A key secondary outcome was death within 1 month of an ED encounter. We extrapolated to make national estimates using US Census and Nationwide Emergency Department Sample data.ResultsAmong a total of 104 113 518 individual patients with 96 239 939 ED encounters, 205 372 ED deaths were identified in Optum, for whom median (IQR) age was 72 (53 to &gt;80) years, 114 582 (55.8%) were male, and 152 672 (74.3%) were White. ED death affected 0.20% of overall patients and accounted for 0.21% of ED encounters. An additional 603 273 patients died within 1 month of an ED encounter. Extrapolated nationally, ED deaths accounted for 11.3% of total deaths from 2010 to 2019, and 33.2% of all decedents nationally visited the ED within 1 month of their death. The proportion of total national deaths occurring in the ED decreased by 0.27% annually (P for trend = .003) but the proportion who died within 1 month of an ED visit increased by 1.2% annually (P for trend &lt; .001). Compared with all ED encounters, patients with visits resulting in death were older, more likely to be White, male, and not Hispanic, and had higher CCI. Among ED encounters for patients aged older than 80 years, nearly 1 in 12 died within 1 month.Conclusions and RelevanceThis retrospective cohort study found deaths during or shortly after ED care were common, especially among patients who are older and with chronic comorbidities. EDs must identify patients for whom end-of-life care is necessary or preferred and be equipped to deliver this care excellently.

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“…Esse dado pode ser útil para informar o planejamento de políticas de saúde e estratégias comunitárias que podem garantir que o atendimento mais adequado seja prestado no local mais apropriado para idosos em fim de vida. Um exemplo seria defender a inscrição precoce em cuidados paliativos (HUANG YL. et.…”

Section: Resultsunclassified

Revisão das metas de cuidado de pessoas em terminalidade de vida nos prontos-socorros (PS) e a determinação da necessidade de cuidados paliativos (CP)

Machado¹,

Ribeiro²,

Cunha³

et al. 2023

Braz. J. Hea. Rev.

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Este artigo visa abordar sobre a prática de Cuidados Paliativos no cenário dos Serviços Médicos de Urgência e Emergência, tendo em vista a falha na administração de cuidados adaptados às necessidades de cada paciente. Objetivo: Objetivou-se neste trabalho verificar a abordagem das equipes de saúde que atuam em serviços médicos de emergências pela ótica dos cuidados paliativos e as possíveis dificuldades para adoção de tais medidas nestes serviços. Metodologia: Trata-se de um estudo de revisão integrativa da literatura, onde foram reunidos e sintetizados resultados de pesquisas sobre a prática de Cuidados Paliativos de pessoas em finitude nos Serviços de Urgência e Emergência, de maneira sistemática e ordenada, que contribuiu para o aprofundamento do conhecimento do tema investigado. Para cruzamento dos dados, utilizou-se busca booleana com o uso do conector and e or que permitiu acessar os artigos que possuíam intersecção entre os diferentes descritores. Foi utilizado como critério de seleção dos estudos aqueles disponíveis na íntegra; aqueles que respondiam à pergunta norteadora; aqueles cujo o tema se enquadrava com os objetivos da pesquisa e aqueles publicados no período dos últimos 5 anos, sendo que, dos 334 artigos encontrados, cinco foram selencionados. Resultados: Foram encontrados 7 artigos, sendo que 70% estavam indexados na BVS, sendo que 40% publicados em 2020. Chama a atenção que todos tem algum médico como coautor. Discussão: Observou-se que o serviço de urgência e emergência é um ambiente essencial para iniciar o Cuidado Paliativo, uma vez que é um local comum de atendimento para pessoas com doenças avançadas e crônicas. Algumas barreiras foram identificadas como dificuldade de comunicação entre equipes e familiares e ausência de treinamento adequado na formação dor profissionais de saúde. Conclusão: A prática dos cuidados paliativos é crucial para que haja respeito à autonomia e à dignidade do paciente, uma vez que a gravidade da doença e das condições em que a pessoa se encontra, impõem a garantia de melhores experiências na atual conjuntura de vida do paciente, o que poderá inclusive, afetar a sua terminalidade de vida. É importante que as diretrizes de cuidados paliativos e de terminalidade de vida nos serviços de Urgência e Emergência sejam baseadas em evidências e adequadas ao propósito.

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Review article: End‐of‐life care for older people in the emergency department: A scoping review

Cited by 17 publications

References 27 publications

The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review

Death and End-of-Life Care in Emergency Departments in the US

Revisão das metas de cuidado de pessoas em terminalidade de vida nos prontos-socorros (PS) e a determinação da necessidade de cuidados paliativos (CP)

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