title: Multidisciplinary team interventions to optimise health outcomes for older people in acute care settings: A systematic review.
abstract: BACKGROUND
  A major challenge facing our health care systems internationally is managing the needs of increasing numbers of older people in hospital with chronic and complex conditions. A multidisciplinary approach is considered central to tailoring and targeting approaches to gerontological care, although this is often not realised in reality. Comprehensive geriatric assessment (CGA) is seen as gold standard, though they are not readily available in many acute settings, compounded by the requirement for time, coordination of multidisciplinary specialties, and reimbursement issues. This systematic review aimed to identify multidisciplinary team interventions to optimise health outcomes for older people in acute care settings.
  
  
  METHODS
  Systematic review of randomised controlled trials reporting acute care multidisciplinary team based interventions, to improve care outcomes for hospitalised older people. Electronic databases (MEDLINE, CINAHL (EBSCO), Cochrane and PsycINFO) were searched from 1 January 2000 to 1 July 2014 in the English language. Data was extracted by two reviewers and checked by a third reviewer to resolve any conflicts.
  
  
  RESULTS
  Seven articles reporting RCTs met the systematic review inclusion criteria. The heterogeneity of study populations, multidisciplinary team interventions and outcome measures necessitated the use of narrative analysis. Three common elements of these studies included: (i) tailored treatment by clinicians with geriatric expertise (ii) a focus on transitional care interventions that enhance discharge planning; and (iii) communication an essential ingredient to improving care.
  
  
  CONCLUSIONS
  The tailoring of treatment, underpinned with clear communication strategies can reduce emergency department re-admission rates, mortality and functional decline of older people. Refining health professionals roles and responsibilities within transition models is an essential component that can improve health outcomes for older people in acute care settings.
authors.affiliation: Faculty of Health, University of Technology Sydney, Australia. Electronic address: louise.hickman@uts.edu.au.
authors.forename: Louise D
authors.initials: LD
authors.lastname: Hickman
authors.affiliation: Centre for Cardiovascular & Chronic Care, Faculty of Health, University of Technology, Sydney, Australia. Electronic address: Jane.Phillips@uts.edu.au.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Phillips
authors.affiliation: Centre for Cardiovascular & Chronic Care, Faculty of Health, University of Technology, Sydney, Australia. Electronic address: Phillip.Newton@uts.edu.au.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.affiliation: School of Nursing, University of Wollongong, Australia. Electronic address: ehalcomb@uow.edu.au.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Halcomb
authors.affiliation: Faculty of Health, University of Technology Sydney, Australia. Electronic address: Naser.A.AlAbed@student.uts.edu.au.
authors.forename: Naser
authors.initials: N
authors.lastname: Al Abed
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, MD 21205, United States. Electronic address: pdavidson@jhu.edu.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015577:Geriatric Assessment / Q000379:methods*; D006282:Health Personnel; D006801:Humans; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team
keywords: Functional health status; Geriatric assessment; Hospitalization; Multidisciplinary; Transition