Early supported discharge for older adults admitted to hospital with medical complaints: a systematic review and meta-analysis

Introduction: Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients  to return home and continue to receive the necessary input from healthcare professionals that they would other‑ wise receive in hospital. The concept has shown reduced length of stay and improved functional outcomes in stroke  patients. This systematic review aims to explore the totality of evidence for the use of early supported discharge in  older adults hospitalised with medical complaints.

Methods: A literature search of CINAHL in EBSCO, Cochrane Central Register of Controlled Trials in the Cochrane  Library (CENTRAL), EMBASE and MEDLINE in EBSCO was carried out. Randomised controlled trials or quasi-randomised  controlled trials were included. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment. The primary out‑ come measure was hospital length of stay. Secondary outcomes included mortality, function, health related quality  of life, hospital readmissions, long-term care admissions and cognition. A pooled meta-analysis was conducted using  RevMan software 5.4.1. 

Results: Five studies met the inclusion criteria. All studies were of some concern in terms of their risk of bias. Statisti‑ cally signifcant efects favouring ESD interventions were only seen in terms of length of stay (REM, MD= -6.04, 95%  CI -9.76 to -2.32, I 2=90%, P=0.001). No statistically signifcant efects favouring ESD interventions were established in  secondary outcomes. 

Conclusion: ESD interventions can have a statistically signifcant impact on the length of stay of older adults admit‑ ted to hospital for medical reasons. There is a need for further higher quality research in the area, with standardised  interventions and outcome measures used.