School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Glucksman Library, Education & Health Sciences, University of Limerick, Limerick, Ireland.
BMC Geriatr. 2022 May 28;22(1):462. doi: 10.1186/s12877-022-03007-5.
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.
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.
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.
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.
UMBRELLA REVIEW REGISTRATION: PROSPERO ( CRD42020145315 ).
人口老龄化在全球范围内迅速加剧。老年人经常使用包括急诊部（ED）在内的医疗保健服务，并在 ED 就诊后经历许多不良后果。不良后果包括功能下降、非计划性住院和 ED 再次就诊。鉴于这些不良后果，已经研究了许多干预措施来改善老年人在 ED 就诊后的结局。本综述的目的是评估 ED 干预措施在减少从 ED 出院的老年人不良结局方面的有效性。
系统检索了针对 ED 就诊的老年人的 ED 干预措施的随机对照试验，探讨了临床、患者体验和医疗保健利用结局。在 2020 年 6 月之前，在 11 个数据库和 PROSPERO 登记处采用了全面的检索策略。还搜索了灰色文献。使用 A MeaSurement Tool to Assess Systematic Reviews 2 工具评估质量。使用证据表矩阵评估系统评价之间的重叠。为所有结局应用了一种算法，将推荐评估、制定和评估分级用于评估证据的强度。
纳入了 9 项系统评价，包括 29 项随机对照试验。干预措施仅包括 ED 为基础或过渡性干预。所提供的具体干预措施差异很大。指导系统评价的试验存在高度重叠和低方法学质量。有低质量证据支持 ED 干预措施可减少功能下降、改善患者体验和提高生活质量。ED 干预措施降低死亡率和 ED 再次就诊的有效性的证据质量从极低到中等不等。结果以叙述方式呈现，并创建了证据汇总表。
由于经济、社会和政治方面的几个原因，老年人是医疗保健中最重要的新兴群体。目前关于 ED 干预措施对老年人有效性的证据有限。本综述强调了由于方法、干预内容和结局报告存在显著异质性，综合证据具有挑战性。建议按照当前老年医学研究指南开展高质量的干预研究，而不是发表更多的系统评价。
伞状评价注册：PROSPERO（CRD42020145315）。
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