What are Older Adults’ perspectives and experiences of care transition and outcomes of care after discharge from the Emergency Department? A Qualitative Evidence Synthesis.

Abstract

Background: Older adults account for 25% of all Emergency Department (ED) attendances and experience high rates of adverse outcomes after being discharged from the ED. Internationally, health policy is promoting Integrated Care for older adults where, ED visits are considered as an integral part of the older adult’s continuum of care. Evidence suggests that by bridging care interventions before and after ED discharge it, can lead to better outcomes for older adults. Currently, it is not known if these bridging care interventions respond to the needs of older adults transitioning from the ED. A comprehensive understanding of older adults’ experiences of transition home from the ED is required. Therefore, a systematic review and synthesis of qualitative studies was completed to describe older adult’s experiences of transition from the ED.
 Who is it for? Policy Makers, Health Care Professionals, Older Adults, Stakeholder Groups, Non-Profit Organisations, Researchers (Older Adults and Integrated Care).
 Who did you involve and engage with? The topic was identified as a priority by an Older Person Panel and the study was conceived by an interdisciplinary group of health researchers. Analysis is on-going currently. Preliminary findings of the qualitative synthesis will be shared and identified themes discussed and refined with this Older Person Panel. Further meetings will be convened to discuss key implications of the findings and to develop a lay summary of the findings for dissemination to relevant stakeholders.
 What did you do? The research question was developed and a protocol for a Qualitative Evidence Synthesis (QES) was registered on PROSPERO. This QES included qualitative studies of older adults (65+) experiences and perspectives of transition from the ED. A full database search was completed using three key search terms: Qualitative Research, ED, and Older Person. 4373 articles were retrieved and 9 articles were included after screening. Included articles were quality assessed using the CASP quality appraisal checklist. Data from the included studies was synthesized using the six-stage approach to meta-ethnography described by Noblit and Hare.
 Findings and Impact: Key findings/themes of this study include: Fragmented Care when transitioning from the ED, the value of communication, risk of readmission to the ED and symptom management. These findings are relevant for those developing interventions for this population.
 Learning for International audience: Address ways to improve the delivery of care for the complex needs among older persons when transitioning between Emergency Department and Integrated Care. Assist with the Clinical Pathway Development of older persons between ED and Integrated Care/Community.
 What are the next steps? A Qualitative Descriptive study using semi structed interviews with older adults to examine their experiences and perspectives of GP Integrated Service i