Key result
Multifaceted interventions cut unplanned readmissions or ED visits by up to ~65% versus control.
Why the study?
Falls in older adults frequently lead to repeated emergency department visits and unplanned hospitalizations, creating a need to inventory interventions designed to prevent them.
Do multifaceted interventions reduce unplanned readmissions or ED visits in older patients presenting to hospital with a fall?
Systematic Review
Do multifaceted interventions reduce unplanned readmissions or ED visits in older patients presenting to hospital with a fall?
Multifaceted and multidisciplinary interventions may reduce unplanned readmissions or ED visits in older patients presenting with a fall, though current evidence is limited and inconsistent.
Answers are grounded in this paper and cite their sources.
May support multifaceted interventions to reduce readmissions after falls; leaves open questions on consistency and optimal components.
OBJECTIVES: Falls are an important issue in older adults as they are frequent, deleterious, and often lead to repeated consultations at the emergency department (ED) and unplanned hospitalizations. Our principal objective was to provide an inventory of interventions designed to prevent unplanned readmissions or ED visits of older patients presenting to hospital with a fall. DESIGN: Systematic review performed on February 11, 2019 in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science, without date or language restriction. We manually updated this search in August 1, 2019. Study selection, data extraction and risk of bias assessment were conducted independently by 2 reviewers. SETTING AND PARTICIPANTS: We included studies reporting interventions to prevent unplanned readmissions or ED visits of older patients (aged 65 years or over) presenting to hospital because of a fall. RESULTS: We identified 475 unique citations after removing duplicates and included 6 studies (2 observational and 4 interventional studies). The studies were published between 2012 and 2019; they evaluated heterogeneous interventions that were frequently multifaceted and multidisciplinary. The interventions were shown effective in reducing readmissions or ED revisits compared with control groups in 3 studies (relative risk reductions between 30% and 65%), all of which were multifaceted and 2/3 multidisciplinary. CONCLUSIONS AND IMPLICATIONS: With 6 articles showing inconsistent results, our study highlights the need to adequately design and evaluate interventions to reduce the burden of hospital readmissions among older fallers. Retrieved studies are recent, which underlines that hospital readmissions are a current concern for researchers and public health authorities [PROSPERO registration number: CRD42019131965].
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Ratsimbazafy et al. (2020) conducted a systematic review in Older patients presenting to hospital for a fall. Multifaceted and multidisciplinary interventions vs. Control groups was evaluated on Unplanned readmissions or ED visits (Relative risk reductions 30-65%). Multifaceted and multidisciplinary interventions reduced unplanned readmissions or ED revisits compared with control groups in 3 of 6 studies, with relative risk reductions between 30% and 65%.
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