Advance Directives for Older Adults in the Emergency Department: A Systematic Review

2015 ◽  
Vol 18 (6) ◽  
pp. 500-505 ◽  
Author(s):  
Jeremy Oulton ◽  
Suzanne Michelle Rhodes ◽  
Carol Howe ◽  
Mindy J. Fain ◽  
Martha Jane Mohler
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Advance Directives

scholarly journals Effectiveness of interventions to alleviate emergency department crowding by older adults: a systematic review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gijs Hesselink ◽  
Özcan Sir ◽  
Yvonne Schoon
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Older Patients ◽  
Elderly Care ◽  
Rapid Assessment ◽  
Experimental Studies ◽  
Design Quality ◽  
Content Type ◽  
Ed Crowding

Abstract Background The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions. Methods Six major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects. Results Of the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician. Conclusion Inter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention’s effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures. Trial registration The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).

scholarly journals Emergency Department Interventions for Older Adults: A Systematic Review

2019 ◽  
Vol 67 (7) ◽  
pp. 1516-1525 ◽  
Author(s):  
Jaime M. Hughes ◽  
Caroline E. Freiermuth ◽  
Megan Shepherd‐Banigan ◽  
Luna Ragsdale ◽  
Stephanie A. Eucker ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department

scholarly journals Risk factors for delirium among older adults in the emergency department: a systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e039175
Author(s):  
Lucas Oliveira J e Silva ◽  
Michelle J Berning ◽  
Jessica A Stanich ◽  
Danielle J Gerberi ◽  
Jin Han ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Risk Factor ◽  
Random Effect ◽  
Quantitative Relationship ◽  
Original Research ◽  
Eligibility Criteria ◽  
Screening Process

IntroductionDelirium is commonly missed in older adults presenting to the emergency department (ED). Although current recommendations for active screening of delirium in the ED, this might not be feasible or practical. Identifying patients at high risk for prevalent and incident delirium in the ED will help to improve the screening process and to build interventions. There is currently scattered synthesis of evidence on risk factors associated with delirium in the ED. To address this gap, we are conducting a systematic review to describe the risk factors (patient vulnerability factors and precipitating factors) for delirium in the ED.Methods and analysisA literature search was performed from inception to March 2020 in Ovid EBM Reviews, Ovid EMBASE, Ovid MEDLINE, Scopus and Web of Science. We will include original research studies that report a quantitative relationship between at least one risk factor and delirium in the ED setting. Two investigators will use eligibility criteria from this protocol to independently screen titles and abstracts, and select studies based on full-text review of potentially eligible studies. After arriving at a final set of included studies, two investigators will extract data using a standardised data collection form. If appropriate, data regarding each risk factor will be pooled through a random-effect meta-analysis. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to evaluate the overall quality of evidence.Ethics and disseminationTo our knowledge, this will be the first systematic review evaluating risk factors for prevalent and incident delirium specifically related to the ED setting. Results of this study will aid in the identification of older adults at risk for delirium in the ED. We aim to publish the results of this systematic review in a peer-reviewed journal with good visibility for the fields of emergency medicine and geriatrics.PROSPERO registration numberCDR42020175261

Geriatric assessment for older adults admitted to the emergency department: A systematic review and meta-analysis

2021 ◽  
Vol 144 ◽  
pp. 111184
Author(s):  
Kristin Häseler-Ouart ◽  
Habibollah Arefian ◽  
Michael Hartmann ◽  
Anja Kwetkat
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Geriatric Assessment ◽  
Meta Analysis

Interventions to improve older adults' Emergency Department patient experience: A systematic review

2020 ◽  
Vol 38 (6) ◽  
pp. 1257-1269 ◽  
Author(s):  
Michelle J. Berning ◽  
Lucas Oliveira J. e Silva ◽  
Nataly Espinoza Suarez ◽  
Laura E. Walker ◽  
Patricia Erwin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Patient Experience ◽  
Emergency Department Patient

Risk Factors for Delirium in Older Adults in the Emergency Department: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Lucas Oliveira J. e Silva ◽  
Michelle J. Berning ◽  
Jessica A. Stanich ◽  
Danielle J. Gerberi ◽  
Mohammad Hassan Murad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Meta Analysis

scholarly journals Diagnostic accuracy of the 4AT for delirium detection: systematic review and meta-analysis

2020 ◽  
Author(s):  
Zoë Tieges ◽  
Alasdair M. J. MacLullich ◽  
Atul Anand ◽  
Claire Brookes ◽  
Marica Cassarino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Emergency Department ◽  
Clinical Practice ◽  
Diagnostic Accuracy ◽  
Diagnostic Test ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Test Accuracy

ABSTRACTObjectiveDetection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 ‘A’s Test (4AT) is a short (<2 min) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection.MethodsWe searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the website www.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults (≥ 65y); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model.Results17 studies (3702 observations) were included. Settings were acute medicine, surgery, a care home, and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8-32.1%; range 10.5-61.9%). The pooled sensitivity was 0.88 (95% CI 0.80-0.93) and the pooled specificity was 0.88 (95% CI 0.82-0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77-0.92) and the pooled specificity was 0.89 (95% CI 0.83-0.93). The methodological quality of studies varied but was moderate to good overall.ConclusionsThe 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection.PROSPERO Registration number CRD42019133702.Key pointsThe 4AT is a short delirium assessment tool that is widely used internationally in clinical practice.This systematic review and meta-analysis of diagnostic accuracy studies of the 4AT included 3702 observations in 17 studies from nine countries.Studies recruited from a range of settings including the Emergency Department, and medical, stroke, and surgical wards.The 4AT had a pooled sensitivity of 0.88 and pooled specificity of 0.88.The methodological quality of studies varied but was moderate to good overall.

Sign in / Sign up

Export Citation Format

Share Document