Efficacy of emergency department-based interventions designed to reduce repeat visits and other adverse outcomes for older XXXX after discharge: A systematic review.

@entity1 @entity341 @entity204
AIM: There is an urgent need for effective geriatric interventions to meet the health service demands of the growing older population. In this paper, we systematically review and update existing literature on interventions within @entity341 ( @entity341 ) targeted towards reducing @entity341 re-visits, hospitalizations, nursing home admissions and @entity204 in older @entity1 after initial @entity341 discharge. METHODS: Databases Medline, CINAHL, Embase and Web of Science were searched to identify all articles published up to June 2012 that focused on older adults in the @entity341 , included a comparison group, and reported quantitative results in four primary outcomes: @entity341 re-visits, hospitalizations, nursing home admissions and @entity204 after initial @entity341 discharge. RESULTS: Of the 2826 titles screened, just nine studies met our inclusion criteria. The studies varied in their design and outcome measurements such that results could not be combined. Two trends surfaced: (i) more intensive interventions more frequently resulted in reduced adverse outcomes than did simple referral intervention types; and (ii) among the lowest intensity, referral-based interventions, studies that used a validated prediction tool to identify high-risk @entity1 more frequently reported improved outcomes than those that did not use such a tool. CONCLUSION: Of the few studies that met the inclusion criteria, there was a lack of consistency and clarity in study designs and evaluative outcomes. Despite this, more intensive interventions that followed @entity1 beyond a referral and the use of a clinical risk prediction tool appeared to be associated with improved outcomes. The dearth of rigorous evaluations with standardized methodologies precludes further recommendations. Geriatr Gerontol Int 2015;       :       -      .
