Risk factors for hospital re-presentation among older adults following fragility fractures: protocol for a systematic review

BackgroundOlder adults hospitalized with fragility fractures are at high risk of negative events that can culminate in re-presentations to hospital emergency departments or readmissions to hospital. This systematic review aimed to identify patient, clinical, or hospital-related factors that are identifiable at the index admission and that may be associated with re-presentations to hospital emergency departments or hospital readmissions in older adults following fragility fractures.MethodsFour electronic databases (PubMed, CINAHL, Embase, and Scopus) were searched. A suite of search terms identified peer-reviewed English-language articles that examined potential correlates of hospital re-presentation in older adults (mean age ≥ 65 years) who were discharged from hospital following treatment for fragility fractures. A three-stage screening process (titles, abstracts, full text) was conducted by two researchers independently. Participant characteristics, study design, potential correlates examined, analyses, and findings were extracted for studies included in the review. Quality and risk of bias were assessed with the Effective Public Health Practice Project Quality Assessment Tool. The strength of evidence was incorporated into a best evidence synthesis, and meta-analysis was conducted where effect pooling was possible.ResultsEleven of 35 eligible studies were categorized as high quality studies. These studies reported that age, higher Cumulative Illness Rating scores, American Society of Anesthesiologists scores > 3, longer length of stay, male sex, cardiovascular disease, low post-operative hemoglobin, kidney disease, dementia and cancer were factors identified at the index admission that were predictive of subsequent re-presentation to hospital. Age was the only predictor for which pooling of effects across studies was possible: pooling was conducted for re-presentation ≤ 30 days (pooled OR, 1.27; 95 % CI, 1.14–1.43) and > 30 days (pooled OR, 1.23; 95 % CI, 1.01–1.50).ConclusionsThe best-evidence synthesis, in addition to the meta-analysis, identified a range of factors that may have utility in guiding clinical practice and policy guidelines for targeted interventions to reduce the need for re-presentation to hospital among this frail clinical population. The paucity of studies investigating re-presentations to hospital emergency departments without admission was an important gap in the literature identified in this review. Key limitations were exclusion of non-English language studies and grey literature.Systematic review registrationPROSPERO CRD42015019379.

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“…The protocol for this systematic review and meta-analysis has previously been reported and is summarized below [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…A third author (SMM) arbitrated any unresolved disagreements arising during any stage in the search and screening process. Further details about the search and selection strategy were outlined in the protocol [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis

Mathew

Gane

Heesch

et al. 2016

BMC Med

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“…Perception of risks associated with discharge is known to impact discharge decision-making and discharge destination (Atwal, McIntyre & Wiggett 2012). These risks include adverse events occurring after discharge, such as failed discharge (Mathew et al 2015), falls at home (Worley, Barras & Grimmer-Somers 2010) and, in extreme cases, death (Yu et al 2011). Clinicians perceive additional risks associated with discharge planning, with these risks being linked closely to accountability and blame in the event of negative outcomes (Bowling & Ebrahim 2001).…”

Section: Introductionmentioning

confidence: 99%

Hospital discharge planning: a qualitative study of new-graduate physiotherapists' experiences

Martin

Phan

Tan

et al. 2022

HEPJ

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Purpose: Discharge planning constitutes a large part of a physiotherapist's role when working in hospital settings. The challenges of decision-making relating to discharge planning have been identified by experienced physiotherapists. Despite known challenges associated with the transition from student to clinician, the experiences of new-graduates undertaking discharge planning are largely unknown. Therefore, this study aimed to explore:1) new-graduate physiotherapists' experiences of discharge planning in hospital settings, and2) the influence of pre-professional training on their perceived preparedness for discharge planning.Design: A qualitative general inductive approach using semi-structured interviews. New-graduate physiotherapists (n = 14) working in hospital settings were recruited.Finding: Four themes were generated: 1) responding to the pressures associated with discharging patients, 2) complex decision-making, 3) the role of the interprofessional team, and 4) desiring additional context and complexity from pre-professional training.Practice Implications: The study has identified that new-graduates underestimate the extent to which discharge planning features in their roles within hospital settings, and are unaware of the interprofessional practice required. Whilst they felt that their pre-professional training provides the technical skills required for their roles, they felt that they were not prepared for their role within the broader healthcare system, nor the complexity of clinical practice. This study encourages education providers to emphasise the role of physiotherapists within the broader health care system, through highlighting contexts where physiotherapy knowledge can be applied (i.e., discharge planning) and understanding the role of the physiotherapist within the interprofessional team.Limitations: Important perspectives of mentors and other members of the interprofessional team involved in discharge planning have not been included in this study which may have impacted the interpretation of the results.

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Center of pressure characteristics from quiet standing measures to predict the risk of falling in older adults: a protocol for a systematic review and meta-analysis

et al. 2019

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Background Falling is the most common accident of daily living and the second most prevalent cause of accidental death in the world. The complex nature of risk factors associated with falling makes those at risk amongst the elderly population difficult to identify. Commonly used clinical tests have limitations when it comes to reliably detecting the risk of falling, but existing laboratory tests, such as force platform measurements, represent one method of overcoming this lack of a test. Despite their widespread use, however, Center of Pressure (COP) signal analysis techniques vary and there is currently no consensus on which features should be used diagnostically. Our objective is to identify, through a systematic review and meta-analysis, the COP characteristics of older adults (≥ 60 years old) during quiet bipedal stance which will allow fallers to be distinguished from non-fallers. Methods The systematic review will include both prospective and retrospective articles. Five databases will be searched: PubMed, Cochrane CENTRAL, EMBASE, and ScienceDirect. In addition, a search of gray literature will be performed using Google Scholar and ClinicalTrials.gov. Searches will be circumscribed to include only older adults (aged over 60 years) who underwent a bipedal quiet standing measure of their balance and for whom the number of falls was reported. Two authors will independently assess the risk of bias for each included article using a 26-item checklist. Funnel plots will be drawn to attest of possible publication biases for each COP parameters. The results will be synthesized descriptively and a meta-analysis will be undertaken. When trial methodological heterogeneity is too great for pooling of the data into a meta-analysis, evidence strength will be evaluated using best evidence analysis. Discussion Despite the numerous advantages of posturography, the diversity of studies exploring balance in older fallers has led to uncertainty regarding the method’s ability to reliably identify fall-prone older adults. It is expected that the findings from this systematic review will help clinicians use bipedal quiet standing measures as a diagnostic test and allow researchers to explore COP characteristics to create better models for fall prevention care. Systematic review registration PROSPERO CRD42018098671 Electronic supplementary material The online version of this article (10.1186/s13643-019-1147-9) contains supplementary material, which is available to authorized users.

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Risk factors for hospital re-presentation among older adults following fragility fractures: protocol for a systematic review

Cited by 3 publications

References 30 publications

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis

Hospital discharge planning: a qualitative study of new-graduate physiotherapists' experiences

Center of pressure characteristics from quiet standing measures to predict the risk of falling in older adults: a protocol for a systematic review and meta-analysis

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