Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

Fan, Lijun and Lukin, William and Zhao, Jingzhou and Sun, Jiandong and Hou, Xiang-Yu (2015) Interventions targeting the elderly population to reduce emergency department utilisation: a literature review. Emergency Medicine Journal, 32 (9). pp. 738-743. ISSN 1472-0205


Objective High utilisation of emergency department (ED) among the elderly is of worldwide concern. This study aims to review the effectiveness of interventions targeting the elderly population in reducing ED utilisation.

Methods Major biomedical databases were searched for relevant studies. Qualitative approach was applied to derive common themes in the myriad interventions and to critically assess the variations influencing interventions’ effectiveness. Quality of studies was appraised using the Effective Public Health Practice Project (EPPHP) tool.

Results 36 studies were included. Nine of 16 community-based interventions reported significant reductions in ED utilisation. Five of 20 hospital-based interventions proved effective while another four demonstrated failure. Seven key elements were identified. Ten of 14 interventions associated with significant reduction on ED use integrated at least three of the seven elements. All four interventions with significant negative results lacked five or more of the seven elements. Some key elements including multidisciplinary team, integrated primary care and social care often existed in effective interventions, while were absent in all significantly ineffective ones.

Conclusions The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Permanent restricted access to Published version in accordance with the copyright policy of the publisher.
Faculty/School / Institute/Centre: No Faculty
Faculty/School / Institute/Centre: No Faculty
Date Deposited: 27 Sep 2021 06:48
Last Modified: 27 Sep 2021 06:48
Uncontrolled Keywords: emergency department; emergency medicine; elderly; intervention; overcrowded
Fields of Research (2008): 11 Medical and Health Sciences > 1117 Public Health and Health Services > 111709 Health Care Administration
11 Medical and Health Sciences > 1103 Clinical Sciences > 110305 Emergency Medicine
Fields of Research (2020): 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320207 Emergency medicine
42 HEALTH SCIENCES > 4203 Health services and systems > 420306 Health care administration
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