A systematic review of interventions to improve outcomes for elders discharged from the emergency department

Objectives: To evaluate the evidence for interventions designed to improve outcomes for elders discharged from the emergency department (ED). Methods: The study was a systematic review of English-language articles indexed in MEDLINE and CINAHL (1966-2005) with 1) key words "geriatric," "older adults," or "seniors," or 2) Medical Subject Heading (MeSH) terms "Geriatrics" or "Health Services for the Aged" AND key word "emergency," or 3) MeSH terms "Emergencies," "Emergency Service, Hospital," or "Emergency Treatment." Bibliographies of the retrieved articles were reviewed for additional references, and the authors consulted with content experts to identify relevant unpublished work. Patients of interest were community-dwelling elder patients discharged home from the ED. Data were abstracted from selected articles by the authors. Studies with interventions limited to patients with a single presentation or diagnosis (falls, delirium, etc.) or delivered only to patients who would have otherwise been hospitalized were not included. Results: Of 669 citations, 27 studies (reported in 33 articles) met study criteria and were reviewed; six randomized controlled trials (RCTs), two nonrandomized clinical trials, and 19 observational studies or program descriptions. Three of four RCTs designed to measure functional outcomes showed a reduction in functional decline in the intervention group. The trials that resulted in functional benefits enrolled high-risk patients and included geriatric nursing assessment and home-based services as part of the intervention. Results of trials to decrease health service utilization rates following an ED visit were mixed. Conclusions: A significant number of programs to improve outcomes for elders discharged from the ED exist, but few have been systematically examined. Development of interventions to improve the care of elder patients following ED visits requires further research into system and patient-centered factors that impact health care delivery in this situation.