Abstract
Background: Older adults are frequent users of Emergency departments (ED) and this trend will continue due to population ageing and the associated increase in healthcare needs. Older adults are vulnerable to adverse outcomes following ED discharge. A number of heterogeneous interventions have been developed and implemented to improve clinical outcomes among this cohort. A growing number of systematic reviews have synthesised evidence regarding ED interventions using varying methodologies. This overview aims to synthesise the totality of evidence in order to evaluate the effectiveness of interventions to reduce adverse outcomes in older adults discharged from the ED. Methods: To identify relevant reviews, the following databases will be searched: Cochrane Database of Systematic reviews, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Databases of Abstracts of Reviews of Effects, PubMed, MEDLINE, Epistemonikos, Ageline, Embase, PEDro, Scopus, CINAHL and the PROSPERO register. The search for grey literature will include Open Grey and Grey Literature Reports. Systematic reviews of randomised controlled trials will be analysed to assess the effect of ED interventions on clinical and process outcomes in older adults. Methodological quality of the reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 tool. The review will be reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Summary of findings will include a hierarchical rank of interventions based on estimates of effects and the quality of evidence. Discussion: This overview is required given the number of systematic reviews published regarding the effectiveness of various ED interventions for older adults at risk of adverse outcomes following discharge from the ED. There is a need to examine the totality of evidence using rigorous analytic techniques to inform best care and potentially develop a hierarchy of treatment options. PROSPERO registration: CRD42020145315 (28/04/2020).
Highlights
Population ageing is increasing rapidly affecting most countries around the world[1]
The PRISMA-P checklist was developed to facilitate the design of protocols of systematic reviews that synthesise accumulated data from primary studies, in particular studies that evaluate the effects of interventions, and not all PRISMA-P items will be applicable for this overview
A hierarchical summary of Emergency departments (ED) interventions will be developed with consideration of the certainty of the evidence and AMSTAR-2. This overview will employ robust methodology to present a synthesis of evidence from systematic reviews regarding the effectiveness of ED interventions and strategies on reducing adverse outcomes in older adults following index visit to the ED
Summary
Population ageing is increasing rapidly affecting most countries around the world[1]. Across Organisation for Economic Co-operation and Development (OECD) countries, the proportion of the population aged over 65 years has increased from less than 9% in 1960 to 17% in 2015 and is expected to rise to 28% in 20502,3 This demographic shift presents both opportunities and challenges[4] longer life is a valuable resource and presents many opportunities to older adults to have productive and healthy years[5]. A growing number of systematic reviews have synthesised evidence regarding ED interventions using varying methodologies This overview aims to synthesise the totality of evidence in order to evaluate the effectiveness of interventions to reduce adverse outcomes in older adults discharged from the ED.
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