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

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 efectiveness 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 specifc 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 efectiveness 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 efectiveness of ED interventions for older adults is limited. This  umbrella review highlights the challenge of synthesising evidence due to signifcant 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