title: Reducing hospital bed use by frail older people: results from a systematic review of the literature.
abstract: BACKGROUND
  Numerous studies have been conducted in developed countries to evaluate the impact of interventions designed to reduce hospital admissions or length of stay (LOS) amongst frail older people. In this study, we have undertaken a systematic review of the recent international literature (2007-present) to help improve our understanding about the impact of these interventions.
  
  
  METHODS
  WE SYSTEMATICALLY SEARCHED THE FOLLOWING DATABASES: PubMed/Medline, PsycINFO, CINAHL, BioMed Central and Kings Fund library. Studies were limited to publications from the period 2007-present and a total of 514 studies were identified.
  
  
  RESULTS
  A total of 48 studies were included for full review consisting of 11 meta-analyses, 9 systematic reviews, 5 structured literature reviews, 8 randomised controlled trials and 15 other studies. We classified interventions into those which aimed to prevent admission, interventions in hospital, and those which aimed to support early discharge.
  
  
  CONCLUSIONS
  Reducing unnecessary use of acute hospital beds by older people requires an integrated approach across hospital and community settings. A stronger evidence base has emerged in recent years about a broad range of interventions which may be effective. Local agencies need to work together to implement these interventions to create a sustainable health care system for older people.
authors.affiliation: Hull and East Yorkshire NHS Hospitals Trust, East Riding of Yorkshire, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Philp
authors.affiliation: 1 Apley Park Mews, Apley Park, Bridgnorth, UK.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Mills
authors.affiliation: Integrated and Community Care, South Warwickshire NHS Foundation Trust, Warwick, UK.
authors.forename: Bhomraj
authors.initials: B
authors.lastname: Thanvi
authors.affiliation: Stroke and Medicine for Older People, South Warwickshire NHS Foundation Trust, Warwick, UK.
authors.forename: Kris
authors.initials: K
authors.lastname: Ghosh
authors.affiliation: Hull and East Yorkshire NHS Hospitals Trust, East Riding of Yorkshire, UK.
authors.forename: Judith F
authors.initials: JF
authors.lastname: Long
keywords: admissions avoidance; hospital bed use; integrated care; older people; systematic review