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Do Geriatric Interventions Reduce Emergency Department Visits? A Systematic Review

Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montréal, Québec, Canada.

Address correspondence to Jane McCusker, MD, DrPH, Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital Center, 3830 Lacombe Ave., Room 2508, Montreal, QC H3T 1M5. E-mail: jane.mccusker{at}mcgill.ca

Background. Hospital emergency departments (EDs) serve an aging population with an increased burden on health resources. Few studies have examined the effects of comprehensive geriatric assessment interventions on ED use. This study aimed to systematically review the literature and compare the effects of these interventions on ED visits.

Methods. Relevant articles were identified through electronic databases and a search of reference lists and personal files. Inclusion criteria included: original research (written in English or French) on interventions conducted in noninstitutionalized populations 60 years old or older, not restricted to a particular medical condition, in which ED visits were a study outcome. Data were abstracted and checked by the first author and a research assistant using a standard protocol.

Results. Twenty-six relevant studies were identified, reported in 28 articles, with study samples obtained from EDs ( 9), hospitals ( 4), outpatient or primary care settings ( 10), home care ( 4), and community ( 1). The study designs included 17 randomized controlled trials, 3 trials with nonrandom allocation, 4 before–after studies, 1 quasi-experimental time-series study, and 1 cross-sectional study. Hospital-based interventions (mostly short-term assessment and/or liaison) had little overall effect on ED utilization, whereas many interventions in outpatient and/or primary care or home care settings (including geriatric assessment and management and case management) reduced ED utilization. Heterogeneity in study methods, measures of comorbidity, functional status, and ED utilization precluded meta-analysis of the results.

Conclusion. Further research, using improved methodologies and standardized measures, is needed to address the effects of innovative geriatric interventions on ED visits.