title: Efficacy of emergency department-based interventions designed to reduce repeat visits and other adverse outcomes for older patients after discharge: A systematic review.
abstract: OBJECTIVE
  There is an urgent need for effective geriatric interventions to meet the health service demands of the growing older population. In this paper, we systematically review and update existing literature on interventions within emergency departments (ED) targeted towards reducing ED re-visits, hospitalizations, nursing home admissions and deaths in older patients after initial ED discharge.
  
  
  METHODS
  Databases Medline, CINAHL, Embase and Web of Science were searched to identify all articles published up to June 2012 that focused on older adults in the ED, included a comparison group, and reported quantitative results in four primary outcomes: ED re-visits, hospitalizations, nursing home admissions and death after initial ED discharge.
  
  
  RESULTS
  Of the 2826 titles screened, just nine studies met our inclusion criteria. The studies varied in their design and outcome measurements such that results could not be combined. Two trends surfaced: (i) more intensive interventions more frequently resulted in reduced adverse outcomes than did simple referral intervention types; and (ii) among the lowest intensity, referral-based interventions, studies that used a validated prediction tool to identify high-risk patients more frequently reported improved outcomes than those that did not use such a tool.
  
  
  CONCLUSIONS
  Of the few studies that met the inclusion criteria, there was a lack of consistency and clarity in study designs and evaluative outcomes. Despite this, more intensive interventions that followed patients beyond a referral and the use of a clinical risk prediction tool appeared to be associated with improved outcomes. The dearth of rigorous evaluations with standardized methodologies precludes further recommendations.
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Karam
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Radden
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Berall
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care
keywords: death; emergency service; geriatric assessment; hospital; hospital readmission; nursing homes