Reducing hospital bed use by frail older people: results from a systematic review of the literature

Introduction 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.

[1]  G. Ottmann,et al.  Multi-professional communication for older people in transitional care: a review of the literature. , 2013, International journal of older people nursing.

[2]  M. Espallargues,et al.  Measuring case-mix and outcome for older people in acute hospital care across Europe: the development and potential of the ACMEplus instrument. , 2008, QJM : monthly journal of the Association of Physicians.

[3]  T. Strandberg,et al.  Frailty in elderly people , 2007, The Lancet.

[4]  K. Krause,et al.  Geriatrics index of comorbidity was the most accurate predictor of death in geriatric hospital among six comorbidity scores. , 2010, Journal of clinical epidemiology.

[5]  R. Johnsen,et al.  Intermediate care at a community hospital as an alternative to prolonged general hospital care for elderly patients: a randomised controlled trial , 2007, BMC public health.

[6]  S. Boonen,et al.  The Effectiveness of Inpatient Geriatric Evaluation and Management Units: A Systematic Review and Meta‐Analysis , 2010, Journal of the American Geriatrics Society.

[7]  John Young,et al.  The development of intermediate care services in England. , 2009, Archives of gerontology and geriatrics.

[8]  P. Fung,et al.  Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. , 2013, Age and ageing.

[9]  Michael Bauer,et al.  Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence. , 2009, Journal of clinical nursing.

[10]  S. Boonen,et al.  Effect of an Inpatient Geriatric Consultation Team on Functional Outcome, Mortality, Institutionalization, and Readmission Rate in Older Adults with Hip Fracture: A Controlled Trial , 2011, Journal of the American Geriatrics Society.

[11]  K. Avlund,et al.  Preventive home visits to home-dwelling older people and hospital admissions: a municipality-randomised intervention trial , 2008, European journal of ageing.

[12]  H. Wald,et al.  Evaluation of a hospitalist-run acute care for the elderly service. , 2011, Journal of hospital medicine.

[13]  Systematic review: interventions intended to reduce admission to hospital of older people , 2010 .

[14]  J. George,et al.  Joint geriatric and psychiatric wards: a review of the literature. , 2011, Age and ageing.

[15]  Matthias Egger,et al.  Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials , 2010, BMJ : British Medical Journal.

[16]  A. Mangoni,et al.  Drug Burden Index, Physical Function, and Adverse Outcomes in Older Hospitalized Patients , 2012, Journal of clinical pharmacology.

[17]  F. C. Bakker,et al.  Effects of hospital-wide interventions to improve care for frail older inpatients: a systematic review , 2011, Quality and Safety in Health Care.

[18]  Is grip strength associated with length of stay in hospitalised older patients admitted for rehabilitation? Findings from the Southampton grip strength study. , 2012, Age and ageing.

[19]  A. Beekman,et al.  The Association between Depressive Symptoms and Non-Psychiatric Hospitalisation in Older Adults , 2012, PloS one.

[20]  Impact of case management by advanced practice nurses in primary care on unplanned hospital admissions: a controlled intervention study , 2008, BMC health services research.

[21]  Wanzhu Tu,et al.  Geriatric care management for low-income seniors: a randomized controlled trial. , 2007, JAMA.

[22]  S. Stock,et al.  Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational study. , 2012, Journal of clinical nursing.

[23]  A. Shmueli,et al.  Deriving a risk-adjustment formula for hospital financing: integrating the impact of socio-economic status on length of stay. , 2008, Social science & medicine.

[24]  E. Stallard,et al.  Insufficient Help for Activity of Daily Living Disabilities and Risk of All‐Cause Hospitalization , 2012, Journal of the American Geriatrics Society.

[25]  K. Iyengar,et al.  Targeted early rehabilitation at home after total hip and knee joint replacement: Does it work? , 2007, Disability and rehabilitation.

[26]  K. Ornstein,et al.  To the Hospital and Back Home Again: A Nurse Practitioner‐Based Transitional Care Program for Hospitalized Homebound People , 2011, Journal of the American Geriatrics Society.

[27]  A. Yohannes,et al.  Prevalence of depression and anxiety symptoms in elderly patients admitted in post‐acute intermediate care , 2008, International journal of geriatric psychiatry.

[28]  Ian A Scott,et al.  Public hospital bed crisis: too few or too misused? , 2010, Australian health review : a publication of the Australian Hospital Association.

[29]  L. Rodríguez-Mañas,et al.  [Efficiency of acute geriatric units: a meta-analysis of controlled studies]. , 2011, Revista espanola de geriatria y gerontologia.

[30]  Eric Howell,et al.  A Quality Improvement Intervention to Facilitate the Transition of Older Adults from Three Hospitals Back to Their Homes , 2009, Journal of the American Geriatrics Society.

[31]  Janice Sorensen,et al.  EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. , 2008, Clinical nutrition.

[32]  J. Gallacher,et al.  Predictors of adverse outcomes on an acute geriatric rehabilitation ward. , 2012, Age and ageing.

[33]  F. Martin,et al.  The older persons' assessment and liaison team 'OPAL': evaluation of comprehensive geriatric assessment in acute medical inpatients. , 2007, Age and ageing.

[34]  Chieh-Yu Liu,et al.  The Relationship Between Nutritional Status and Physical Function, Admission Frequency, Length of Hospital Stay, and Mortality in Old People Living in Long-Term Care Facilities , 2012, The journal of nursing research : JNR.

[35]  P. Langhorne,et al.  Medical day hospital care for the elderly versus alternative forms of care. , 2000, The Cochrane database of systematic reviews.

[36]  Jennifer Dixon,et al.  Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial , 2013, Age and ageing.

[37]  L. Homer,et al.  Effects of a Geriatrician‐Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes , 2009, Journal of the American Geriatrics Society.

[38]  Patti Pagel,et al.  Acute Care for Elders (ACE) Tracker and e‐Geriatrician: Methods to Disseminate ACE Concepts to Hospitals with No Geriatricians on Staff , 2010, Journal of the American Geriatrics Society.

[39]  I. Kronborg,et al.  Integrated care facilitation for older patients with complex health care needs reduces hospital demand. , 2007, Australian health review : a publication of the Australian Hospital Association.

[40]  T. Alarcón,et al.  Eficiencia de las unidades geriátricas de agudos en los hospitales españoles , 2009 .

[41]  S Shepperd,et al.  Discharge planning from hospital to home. , 2000, The Cochrane database of systematic reviews.

[42]  H. Handoll,et al.  Multidisciplinary rehabilitation for older people with hip fractures. , 2009, The Cochrane database of systematic reviews.

[43]  M. Chren,et al.  Acute care for elders units produced shorter hospital stays at lower cost while maintaining patients' functional status. , 2012, Health affairs.

[44]  Ruth Boaden,et al.  Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data , 2006, BMJ : British Medical Journal.

[45]  T. Alarcón,et al.  [The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact]. , 2011, Revista espanola de geriatria y gerontologia.

[46]  M. Boone,et al.  This article is published in a peer-reviewed section of the Utrecht Law Review , 2014 .

[47]  M. Baxter,et al.  Geriatrician input into nursing homes reduces emergency hospital admissions. , 2012, Archives of gerontology and geriatrics.

[48]  S. Ebrahim,et al.  Maintaining independence in older people , 2010 .

[49]  P. Bower,et al.  Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial , 2013, BMJ : British Medical Journal.

[50]  A. Chin,et al.  Grip strength in a cohort of older medical inpatients in Malaysia: a pilot study to describe the range, determinants and association with length of hospital stay. , 2013, Archives of gerontology and geriatrics.

[51]  B. Middel,et al.  Effects of Case Management for Frail Older People or Those With Chronic Illness: A Systematic Review , 2009, Nursing research.

[52]  Laura Lorén Guerrero,et al.  Biopsychosocial factors related to the length of hospital stay in older people. , 2011, Revista latino-americana de enfermagem.

[53]  S. Gates,et al.  Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis , 2007, BMJ : British Medical Journal.

[54]  K. Choi.  [Hip fracture]. , 1963, [Chapchi] Journal. Taehan Oekwa Hakhoe.

[55]  Nazmi Sari.  A short walk a day shortens the hospital stay: physical activity and the demand for hospital services for older adults. , 2010, Canadian journal of public health = Revue canadienne de sante publique.

[56]  Peter Langhorne,et al.  Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials , 2011, BMJ : British Medical Journal.

[57]  R. Melis,et al.  Cost-effectiveness of a multidisciplinary intervention model for community-dwelling frail older people. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[58]  N. Clement,et al.  The outcome of fractures in very elderly patients. , 2011, The Journal of bone and joint surgery. British volume.

[59]  T. Haines,et al.  Nutritional status and associations with falls, balance, mobility and functionality during hospital admission , 2011, The journal of nutrition, health & aging.

[60]  M. Orrell,et al.  The effectiveness of crisis resolution/home treatment teams for older people with mental health problems: a systematic review and scoping exercise , 2011, International journal of geriatric psychiatry.

[61]  Patriek Mistiaen,et al.  BMC Health Services Research BioMed Central , 2005 .

[62]  J. Addington-hall,et al.  Outcomes After Unplanned Admission to Hospital in Older People: Ill‐Defined Conditions as Potential Indicators of the Frailty Trajectory , 2012, Journal of the American Geriatrics Society.

[63]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[64]  J. Greenwood,et al.  Social Issues Prolong Elderly Burn Patient Hospitalization , 2011, Journal of burn care & research : official publication of the American Burn Association.

[65]  K. Sawanyawisuth,et al.  Delirium in hospitalized elderly patients of Thailand; is the figure underrecognized? , 2012, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[66]  R. Heun,et al.  Reasons for Hospital Admissions in Dementia Patients in Birmingham, UK, during 2002–2007 , 2008, Dementia and Geriatric Cognitive Disorders.

[67]  R. Holland,et al.  Home-based medication review in a high risk elderly population in primary care--the POLYMED randomised controlled trial. , 2007, Age and ageing.

[68]  Influencia de la dependencia funcional en la casuística de una unidad de geriatría , 2008 .

[69]  J. G. González Montalvo,et al.  [The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact]. , 2011, Revista espanola de geriatria y gerontologia.

[70]  C. Meisinger,et al.  The Geriatric Nutritional Risk Index predicts increased healthcare costs and hospitalization in a cohort of community-dwelling older adults: results from the MONICA/KORA Augsburg cohort study, 1994-2005. , 2011, Nutrition.

[71]  K. Krause,et al.  Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients , 2009, International journal of geriatric psychiatry.

[72]  Rachael Gooberman-Hill,et al.  Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis , 2008, The Lancet.

[73]  A. Mudge,et al.  Exercising Body and Mind: An Integrated Approach to Functional Independence in Hospitalized Older People , 2008, Journal of the American Geriatrics Society.

[74]  T. Perneger,et al.  A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility , 2008, BMC health services research.

[75]  A. Forster,et al.  Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review. , 2012, Reviews in clinical gerontology.

[76]  J. Keating,et al.  Exercise for acutely hospitalised older medical patients. , 2007, The Cochrane database of systematic reviews.

[77]  Lalit Kalra,et al.  Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data , 2009, Canadian Medical Association Journal.

[78]  M. Wallis,et al.  Predictive outcomes for older people who present to the emergency department , 2008 .

[79]  D. O’Neill,et al.  Loneliness and Emergency and Planned Hospitalizations in a Community Sample of Older Adults , 2010, Journal of the American Geriatrics Society.

[80]  O. Førde,et al.  Does long-term care use within primary health care reduce hospital use among older people in Norway? A national five-year population-based observational study , 2011, BMC health services research.

[81]  B. Draper,et al.  The Hospital Dementia Services Project: age differences in hospital stays for older people with and without dementia , 2011, International Psychogeriatrics.