Unplanned Transfer to Emergency Departments for Frail Elderly Residents of Aged Care Facilities: A Review of Patient and Organizational Factors.
BACKGROUND
With an aging population, a growing number of older adults experience physical or cognitive decline that necessitates admission to residential aged care facilities (RACF). Each year a considerable proportion of these residents has at least 1 emergency transfer to hospital, which may result in a number of adverse outcomes. Rates of transfer from RACF to hospital can vary considerably between different RACFs suggesting the presence of potentially modifiable risk factors for emergency department (ED) transfer.


METHODS
A systematic and comprehensive search of the peer-reviewed literature using 4 electronic databases was conducted. Included papers were those reporting on determinants of unplanned transfer to hospital for elderly people (aged 65 years and above) living in RACFs. Studies were assessed for quality and key concepts and themes extracted.


RESULTS
There are both individual patient factors and health system factors, which influence rates of transfer to hospital for elderly RACF residents. For individuals, increased risk of ED transfer has been associated with presence of particular comorbidities such as chronic airways disease, congestive cardiac failure, and diabetes; presence of indwelling devices; absence of an advance care plan; and reduced functional ability. For organizations, "for profit" facilities and those with poorer staff to patient ratios also have higher rates of transfer to hospital, compared with those owned by not-for-profit organizations and those with improved registered nurse and medical practitioner staffing.


CONCLUSIONS
This review has identified a number of potentially modifiable patient and organizational factors that should reduce the need for burdensome transfer to the ED and improve the quality of both acute care and end-of-life care for this population of frail, elderly individuals. A number of these determinants, including facility staffing, the role of specialist geriatricians, and advance directives, should be further examined, ideally through interventional trials to evaluate their impact on the pre-hospital and emergency management of these patients.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: rosamond.dwyer@monash.edu.
Rosamond
R
Dwyer
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Just
J
Stoelwinder
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Farr Institute, Center for Improvement in Population Health through E-Records Research (CIPHER), College of Medicine, Swansea University, Swansea, Wales, United Kingdom.
Belinda
B
Gabbe
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Judy
J
Lowthian
D000369:Aged, 80 and over; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D016330:Frail Elderly; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D010360:Patient Transfer; D012307:Risk Factors
Elderly; acute care; emergency department; geriatrics