title: Interventions targeting the elderly population to reduce emergency department utilisation: a literature review.
abstract: 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.
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Lijun
authors.initials: L
authors.lastname: Fan
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Lukin
authors.affiliation: Bureau of Investment Promotion, Wuwei, Gansu, People's Republic of China.
authors.forename: Jingzhou
authors.initials: J
authors.lastname: Zhao
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Jiandong
authors.initials: J
authors.lastname: Sun
authors.affiliation: School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Xiang-Yu
authors.initials: XY
authors.lastname: Hou
mesh_terms: D000368:Aged; D003153:Community Health Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006299:Health Services for the Aged; D006801:Humans
keywords: aged; effectiveness; emergency care systems; emergency department; epidemiology