Table 2 Targeted care interventions for older adults in the ED, by intervention category and level of evidence

Targeted care to improve system performance

Basic et al., 2005, Australia [64]

Admission to the hospital, OR (95% CI)

0.7 (0.3, 1.7)

NR

II

ne

Hospital LOS, hazard ratio (95% CI)

1.1 (0.7, 1.5)

NR

ne

Functional decline during the hospitalisation, OR (95% CI)

1.3 (0.5, 3.3)

NR

ne

McCusker et al., 2003a, Canada [62]

4-month decline in functional status or death, OR (95% CI)

0.5 (0.3—0.9)

NR

II

ne

Depressive symptom change, OR (95% CI)

-0.5 (-1.3, 0.3)

NR

ne

4-month difference in health care costs after index visit, CA$ (95% CI)

-387 (-1411, 638)

NR

ne

McCusker et al., 2003b, Canada [63]

Referrals to primary physician, OR (95% CI)

1.9 (1.0, 3.4)

II

 + 

Compliance with referrals, OR (95% CI)

1.2 (0.7, 2.3)

ne

30-day ED re-presentations, OR (95% CI)

1.6 (1.0, 2.6)

-

Ageron et al., 2016, France [70]

Fall-related ED attendance, n (%); relative risk ratio (95% CI)

46/144 (32); 1.3 (0.9, 1.7)

52/130 (40)

NR

III-2

ne

Fall-related hospital admission, n (%); relative risk ratio (95% CI)

19/144 (13); 1.1 (0.6, 2.0)

19/130 (15)

NR

ne

1-year mortality

29/144 (20); 1.0 (0.7, 1.6)

27/130 (21)

NR

ne

Mortality during hospital stay

50/2,426 (2.1)

61/2,684 (2.3)

0.61

ne

Fall recurrence within 1 month in older adults discharged, not living in an aged care facility, and without cognitive impairment

29/2,426 (3.6)

17/2,684 (2.0)

0.05

ne

Hospital LOS (days), mean (SD)

13.1 (12.7)

11.6 (9.1)

 < 0.01*

 + 

Brymer et al., 2001, UK [73]

Change in assessment practices of ED nurses

III-2

Routinely assesses for depression

↑

 < 0.001*

 + 

Routinely assesses for altered mental status

↑

 < 0.01*

 + 

Routinely assesses for dementia

no change

0.54

ne

Routinely asks what client weighs

no change

0.10

ne

Routinely asks if unplanned weight loss

no change

0.23

ne

Routinely asks if there is assistance in the home

0.05

ne

Chong et al. 2021, Singapore [66]

1-month rehospitalisation, IRR (95% CI)

1.5 (0.5, 4.4)

0.42

III-2

ne

3-month rehospitalisation, IRR (95% CI)

0.9 (0.5, 1.7)

0.74

ne

6-month rehospitalisation, IRR (95% CI)

0.8 (0.5, 1.3)

0.33

ne

1-month ED re-attendance, IRR (95% CI)

1.7 (0.6, 4.7)

0.29

ne

3-month ED re-attendance, IRR (95% CI)

0.9 (0.4, 1.8)

0.74

ne

6-month ED re-attendance, IRR (95% CI)

0.6 (0.3, 1.0)

0.08

ne

Mortality (over study period), IRR (95% CI)

0.3 (0.1, 1.3)

0.11

ne

Institutionalisation (over study period), IRR (95% CI)

0.8 (0.2, 3.9)

0.82

ne

3-month fall, IRR (95% CI)

0.4 (0.1, 1.9)

0.23

ne

6-month fall, IRR (95% CI)

0.4 (0.1, 1.5)

0.18

ne

1-month polypharmacy (≥ 5 medications), IRR (95% CI)

1.95 (0.7, 5.7)

0.22

ne

3-month polypharmacy (≥ 5 medications), IRR (95% CI)

0.9 (0.3, 2.5)

0.83

ne

6-month polypharmacy (≥ 5 medications), IRR (95% CI)

0.9 (0.4, 2.3)

0.89

ne

1-month increase in CFS score from baseline (≥ 5 medications), IRR (95% CI)

0.4 (0.2, 1.0)

0.06

ne

3-month increase in CFS score from baseline (≥ 5 medications), IRR (95% CI)

0.4 (0.2, 1.0)

0.05

ne

6-month increase in CFS score from baseline (≥ 5 medications), IRR (95% CI)

0.3 (0.1, 0.9)

0.04*

 + 

1-month progression in CFS category from baseline (≥ 5 medications), IRR (95% CI)

0.2 (0.1, 0.5)

 < 0.001*

 + 

3-month progression in CFS category from baseline (≥ 5 medications), IRR (95% CI)

0.1 (0.0, 0.4)

 < 0.001

 + 

6-month progression in CFS category from baseline (≥ 5 medications), IRR (95% CI)

0.2 (0.1, 0.7)

0.01*

 + 

Miller et al., 1996, USA [67]

ED LOS (minutes), mean

292

231

 < 0.001*

III-2

 + 

Subsequent visits to emergency departments

unclear

unclear

0.06

ne

Number of new dental or social services initiated per patient, mean

1.5

1.7

NR

ne

Advance care directives, %

2.9

6.7

0.07

ne

3-month mortality, %

9.7

9.3

NR

ne

O' Keeffe et al., 2020, Ireland [71]

Hospital admission, n (%)

8 (14)

7 (9)

0.11

III-2

ne

Liberman et al., 2018, USA [72]

Identified as having advanced illness in the ED, %

0.0

90.2

 < 0.001*

III-2

 + 

Received an ED-led Goals of Care discussion (%)

0.0

83.6

 < 0.001*

 + 

Patients referred to hospice from the ED (%)

0.0

39.3

 < 0.001*

 + 

Newton-Brown et al., 2014, Australia [74]

Received nerve block, n (%; 95% CI)

17/70 (24.3; 15.8, 35.5)

35/66 (53.0; 41.2, 64.6)

 < 0.01*

III-2

 + 

Nerve block documented in medical record, n (%; 95% CI)

12/17 (70.6; 46.9, 86.7)

33/35 (94.3; 81.4, 98.4)

 < 0.01*

 + 

Scarpazza et al., 2008, Italy [75]

Successfully treated, n (%)

54/62 (87.1)

III-3

 + 

Hospital LOS, mean (SD)

13.7 (5.1)

Basic et al. 2002a, Australia [65]

Not admitted to hospital

142/469 (30.2)

N/A

Puig Campmany et al. 2019, Spain [68]

Hospital admissions, %

12%

11.3%

NR

N/A

 + 

Tousignant-Laflamme et al. 2015, Canada [69]

Implementation facilitators

Easy access to the list of patients admitted in the ED; sufficient time to provide PT with help of 4th year physiotherapy student; good collaboration with nursing staff

N/A

Implementation barriers

Fast transfer of patients from ED and lack of space to provide optimal PT; lack of time to complete screening document; lack of communication between shifts, nursing staff turnover

Assessed by physiotherapist in the ED after screening, n (%)

20/187

Assessed by physiotherapist and received PT treatment in the ED and developed immobilization syndrome, n (%)

0/9

Assessed by physiotherapist and did not receive PT treatment in the ED and developed immobilization syndrome

2/11

Targeted care to improve patient outcomes

Shaw et al., 2003, UK [81]

Falls one-year post intervention, n (%); relative risk ratio (95% CI)

115/144 (80); 0.9 (0.8, 1.1)

96/130 (74)

NR

II

ne

Chong et al. 2022, Singapore [78]

3-month MBI, mean (SD)

90.2 (17.4)

95.5 (7.8)

0.05

III-2

ne

6-month MBI, mean (SD)

88.5 (19.5)

94.5 (11.2)

0.04*

 + 

12-month MBI, mean (SD)

90.2 (18.0)

93.6 (15.2)

0.3

ne

3-month instrumental ADLs, mean (SD)

5.1 (2.4)

5.7 (1.9)

0.15

ne

6-month instrumental ADLs, mean (SD)

4.9 (2.6)

5.4 (2.4)

0.22

ne

12-month instrumental ADLs, mean (SD)

4.7 (2.5)

5.7 (2.4)

0.05

ne

3-month CFS, mean (SD)

4.9 (1.0)

4.7 (0.8)

0.26

ne

6-month CFS, mean (SD)

4.8 (0.9)

4.6 (0.7)

0.19

ne

12-month CFS, mean (SD)

5.0 (1.0)

4.8 (0.9)

0.18

ne

3-month FI, mean (SD)

0.23 (0.08)

0.22 (0.06)

0.32

ne

6-month FI, mean (SD)

0.25 (0.07)

0.22 (0.06)

0.02*

 + 

12-month FI, mean (SD)

0.25 (0.09)

0.23 (0.07)

0.02*

 + 

3-month SARC-F, mean (SD)

3.8 (2.4)

3.3 (2.2)

0.23

ne

6-month SARC-F, mean (SD)

4.1 (2.8)

3.1 (2.4)

0.04*

 + 

12-month SARC-F, mean (SD)

3.7 (2.8)

3.0 (2.4)

0.22

ne

3-month CCI, mean (SD)

1.9 (2.0)

2.3 (2.3)

0.42

ne

6-month CCI, mean (SD)

1.9 (1.9)

2.4 (2.2)

0.28

ne

12-month CCI, mean (SD)

2.0 (2.0)

1.8 (1.7)

0.62

ne

Foo et al., 2012, Singapore [76]

3-month falls, n (%); IRR (95% CI)

20/93 (11.6); 0.91 (0.44, 1.90)

23/177 (7.3)

NR

III-2

ne

3-month mortality, n (%); IRR (95% CI)

1/88 (0.58); 0.81 (0.06, 11.81)

2/162 (0.63)

NR

ne

3-month ED re-attendance, n (%); IRR (95% CI)

49/169 (28.5); 0.58 (0.42, 0.81)

54/293 (17.1)

NR

 + 

3-month hospitalisation, n (%); IRR (95% CI)

40/169 (23.3); 0.61 (0.41, 0.92)

48/293 (15.2)

NR

 + 

Foo et al. 2014, Singapore [77]

MBI at baseline, n (difference)

500/500 (0)

280/280 (0)

0.1

III-2

ADL at baseline, n (difference)

500/500 (0)

280/280 (0)

 < 0.01*

MBI difference at 3 months, n (difference)

479/500 (-0.25)

269/280 (0)

 < 0.01*

 + 

ADL difference at 3 months, n (difference)

479/500 (-0.33)

269/280 (0.53)

 < 0.01*

 + 

MBI difference at 6 months, n (difference)

469/500 (-0.53)

260/280 (0.03)

 < 0.01*

 + 

ADL difference at 6 months, n (difference)

469/500 (-1.24)

260/280 (0.6)

 < 0.01*

 + 

MBI difference at 9 months, n (difference)

439/500 (-0.78)

248/280 (-0.08)

 < 0.01*

 + 

ADL difference at 9 months, n (difference)

439/500 (-2.02)

248/280 (0.63)

 < 0.01*

 + 

MBI difference at 12 months, n (difference)

423/500 (-0.99)

234/280 (-0.24)

 < 0.01*

 + 

ADL difference at 12 months, n (difference)

423/500 (-2.57)

234/280 (0.45)

 < 0.01*

 + 

Intention-to-treat analysis

3-month ED attendance, OR (95%CI)

0.9 (0.6, 1.2)

NR

ne

6-month ED attendance, OR (95%CI)

0.8 (0.6, 1.1)

NR

ne

9-month ED attendance, OR (95%CI)

0.7 (0.6,1.0)

NR

ne

12-month ED attendance, OR (95%CI)

0.8 (0.6,1.0)

NR

ne

3-month hospitalisation, OR (95%CI)

0.9 (0.6, 1.2)

NR

ne

6-month hospitalisation, OR (95%CI)

0.8 (0.6, 1.1)

NR

ne

9-month hospitalisation, OR (95%CI)

0.8 (0.6, 1.0)

NR

ne

12-month hospitalisation, OR (95%CI)

0.8 (0.6, 1.0)

NR

ne

Per protocol analysis

3-month ED attendance, OR (95%CI)

0.8 (0.6, 1.1)

NR

ne

6-month ED attendance, OR (95%CI)

0.7 (0.5, 0.9)

NR

 + 

9-month ED attendance, OR (95%CI)

0.6 (0.5, 0.9)

NR

 + 

12-month ED attendance, OR (95%CI)

0.7 (0.4, 0.8)

NR

 + 

3-month hospitalisation, OR (95%CI)

0.8 (0.6, 1.2)

NR

ne

6-month hospitalisation, OR (95%CI)

0.8 (0.6, 1.1)

NR

ne

9-month hospitalisation, OR (95%CI)

0.7 (0.5, 0.9)

NR

 + 

12-month hospitalisation, OR (95%CI)

0.8 (0.6, 1.0)

NR

ne

Hogan et al., 2016, USA [80]

Change in pain score (initial to follow-up), median (IQR)

-1.0 (-3.0, 0.0)

-3.0 (-5.0, -1.0)

 < 0.001*

III-2

 + 

Change in pain score (initial to final), median (IQR)

0.0 (-2.0, 0.0)

-5.0 (-7.0, -2.0)

 < 0.001*

 + 

Received pain score in triage, n (%)

427 (85.6)

294 (85.7)

0.95

ne

Received medicine after initial pain score, n (%)

320 (64.1)

291 (84.8)

 < 0.001*

 + 

Time to first medication after arrival (minutes), median (IQR)

118 (64, 240)

118 (61, 213)

0.70

ne

Reassessment after first medication, n (%)

166/499 (51.9)

240/343 (82.5)

 < 0.01*

 + 

Time to first reassessment after first medication (minutes), median (IQR)

86.0 (20.0, 199.0)

65.0 (27.0, 175.0)

0.60

ne

Lesser et al., 2018, USA [79]

30-day ED re presentations, (OR)

0.7

 < 0.001*

III-2

 + 

60-day ED re presentations, (OR)

0.7

 < 0.001*

 + 

Mahony et al., 2008, USA [82]

ED attendance 12-months before index visit, %

59

N/A

ED attendance 12-months after index visit, %

45

ne

Satisfaction with symptom control post ED-discharge, n (%)

14/20 (69)

 + 

Targeted care to improve patient experience

McCusker et al., 2001, Canada [83]

Change at 4 months compared to baseline

II

Functional decline, OR (95% CI)

0.5 (0.3, 0.9)

 + 

Depressive symptoms, OR (95% CI)

-0.5 (-1.3, 0.3)

ne

Caregiver mental health, OR (95% CI)

-2.2 (-5.9, 1.6)

ne

Caregiver satisfaction, OR (95% CI)

0.71 (-0.6, 2.0)

ne

Patient satisfaction, OR (95% CI)

0.66 (-0.24, 1.55)

ne

Boucher et al. 2019, Canada [84]

Adjusted Treatment Acceptability and Preferences scale scores (Research Assistant evaluation vs patient self-assessment), mean

2.20

2.36

0.08

III-1

 + 

Liberman et al., 2020, USA [85]

30-day ED revisit, mean (%)

0.22

0.20

0.34

III-2

ne

Hospital admission at 30-day revisit, n (%)

35 (57)

23 (40)

0.01

 + 

Patient satisfaction

Found the Geriatric and Palliative-ED Specialist helpful in providing support and resources, %

220/242 (91)

 + 

Think EDs should have a Geriatric and Palliative-ED team to consult patients and caregivers

219/242 (90)

 + 

Targeted care to improve staff experience

Arendts et al., 2020, Australia [87]

ED discharge, %

46

66

0.001*

III-2

 + 

ED LOS (hours), mean

6.5

3.6

 < 0.001*

 + 

Hospital LOS (days), mean

6

2

 < 0.001*

 + 

28-day re-presentation rate to the ED

NR

NR

NR

ne

Staff views on pathway

Staff aware of pathway, n (%)

34/34 (100)

NR

 + 

Believed pathway improved overall care and improved knowledge of falls patients,

19/34 (56)

NR

 + 

Desy et al., 2008, USA [88]

Total knowledge score, mean (SD)

23.9 (2.5)

27.2 (1.4)

 < 0.001*

III-2

 + 

Self-rated ability to provide geriatric care

NS

ne

Use of geriatric assessment tools

MMSE, %

↑

0.01*

 + 

Pain assessment, %

↓

0.03*

-

Braden scale for predicting pressure sore risk, %

↓

0.01*

-

Urinary incontinence assessment, %

↑

 < 0.01*

 + 

Falls risk assessment, %

↑

0.01*

 + 

Pain assessment in patients with dementia, %

↑

0.01*

 + 

Incorporated knowledge learned 3-months after attending course

Completely, %

37

 + 

Somewhat, %

51

 + 

EDs incorporating geriatric protocols of care, %

12

21

 < 0.01*

 + 

Elliott et al. 2017, UK [86]

Ideal tool characteristics

Tools should be multidimensional, short (< 5 min), and validated

N/A

Timing between CFS, ISAR, PRISMA-7, and Silver Code

No significant differences between professions for the time taken to complete an assessment

 + 

Ease of use between CFS, ISAR, PRISMA-7, and Silver Code

No significant differences in ease of use

 + 

Agreement with clinical judgement between CFS, ISAR, PRISMA-7, and Silver Code

Good agreement between participants’ clinical judgement

 +