Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis
Abstract Aim Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are prolifer...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-03-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-024-04751-6 |
| _version_ | 1797266621566287872 |
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| author | Brian Condon Anne Griffin Christine Fitzgerald Elaine Shanahan Liam Glynn Margaret O’Connor Christina Hayes Molly Manning Rose Galvin Aoife Leahy Katie Robinson |
| author_facet | Brian Condon Anne Griffin Christine Fitzgerald Elaine Shanahan Liam Glynn Margaret O’Connor Christina Hayes Molly Manning Rose Galvin Aoife Leahy Katie Robinson |
| author_sort | Brian Condon |
| collection | DOAJ |
| description | Abstract Aim Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults’ experiences of transition to the community from the ED. Methods Six databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise findings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990). Findings Ten studies were included, and synthesis led to the development of five themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult’s ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance. Discussion/ conclusion Key areas for consideration in future service and intervention development are identified in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults’ changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life. |
| first_indexed | 2024-04-25T01:03:36Z |
| format | Article |
| id | doaj.art-35d6deb46a57479a9e9714c44e0c8b4d |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-25T01:03:36Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-35d6deb46a57479a9e9714c44e0c8b4d2024-03-10T12:21:39ZengBMCBMC Geriatrics1471-23182024-03-0124111410.1186/s12877-024-04751-6Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesisBrian Condon0Anne Griffin1Christine Fitzgerald2Elaine Shanahan3Liam Glynn4Margaret O’Connor5Christina Hayes6Molly Manning7Rose Galvin8Aoife Leahy9Katie Robinson10School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of LimerickSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of LimerickSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of LimerickDepartment of Ageing and Therapeutics, University Hospital LimerickSchool of Medicine, Faculty of Education and Health Sciences, University of LimerickDepartment of Ageing and Therapeutics, University Hospital LimerickSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of LimerickSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of LimerickSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of LimerickSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of LimerickSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of LimerickAbstract Aim Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults’ experiences of transition to the community from the ED. Methods Six databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise findings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990). Findings Ten studies were included, and synthesis led to the development of five themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult’s ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance. Discussion/ conclusion Key areas for consideration in future service and intervention development are identified in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults’ changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life.https://doi.org/10.1186/s12877-024-04751-6Older adultEmergency departmentCare transitionQualitative evidence synthesismeta-ethnography |
| spellingShingle | Brian Condon Anne Griffin Christine Fitzgerald Elaine Shanahan Liam Glynn Margaret O’Connor Christina Hayes Molly Manning Rose Galvin Aoife Leahy Katie Robinson Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis BMC Geriatrics Older adult Emergency department Care transition Qualitative evidence synthesis meta-ethnography |
| title | Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis |
| title_full | Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis |
| title_fullStr | Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis |
| title_full_unstemmed | Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis |
| title_short | Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis |
| title_sort | older adults experience of transition to the community from the emergency department a qualitative evidence synthesis |
| topic | Older adult Emergency department Care transition Qualitative evidence synthesis meta-ethnography |
| url | https://doi.org/10.1186/s12877-024-04751-6 |
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