Impact of health and social care interventions on unplanned hospital admissions, timely discharge and well-being of community dwelling older population: A mixed methods meta-review of systematic reviews

Problem

It is predicted that by 2020, the population >65 years, >85 years and >100 years will increase by 12% (1.1 million), 18% (300,000) and 40% (7,000) respectively. Hospital episodes for the >65yrs population have continued to increase, rising to £6.3 million between 2016-2017.Whilst some older people need to be admitted to the hospital, evidence suggests that timely care provision in the community is more appropriate for many. Our aim was to identify and examine systematic reviews (SRs) evidence of health and social care (HAS) interventions for the community-dwelling older population regarding the outcomes 1) unplanned hospital admissions 2) timely hospital discharge and 3) patient well-being.

Approach

We developed a comprehensive a search strategy and searched eight bibliometric medical and social science databases. Medical Subject headings and keywords for (i) health care, (ii) social care and (iii) systematic reviews/meta-analyses were combined to retrieve the relevant literature and were tested for sensitivity and specificity. Searches were restricted to Organisation for Economic Co-operation and Development countries and to those published from 2009 onwards to reflect the recent changes to care provision in developed nations e.g. GP out of hours contract changes 2004. Additionally, citation searches and reference lists of included reviews supplemented the database searches. Data extraction and risk of bias assessment were carried out by one reviewer with a random sample of 20% and 10% double screened by two other reviewers. This review will be documented following the PRISMA guidance. This review is registered on PROSPERO as CRD42018087534.

Findings

Searches retrieved 8720 papers. Following title and abstract screening, we identified 134 relevant papers for full-text screening and included 78 reviews in our synthesis. These systematic reviews have been grouped into reviews which describe a variety of admission avoidance/alternative interventions (n=9), transitional care (n=7), cognitive/psychosocial interventions (n=2), exercise/rehabilitation (n=18), medication review (n=6), seasonal vaccination (n=1), ED-based interventions (n=5), preventative home visits (n=3), integrated HAS care (n=9), Social care services (n=8) and targeting social isolation interventions (n=10). Most of the reviews describe studies that recruited a mixed, older population (n=53), the remaining describe specific patient groups e.g. heart failure & COPD. Only ten of the reviews focused on qualitative studies. We are currently preparing a paper comparing the effectiveness of health versus social care versus combined HAS interventions with respect to our three outcome measures.

Consequences

To our knowledge this is the first meta-review investigating the effectiveness of health and social interventions for the community-dwelling older population. Our analysis will summarise the comparative effectiveness of health, social and combined HAS interventions on hospital admissions, timely discharge and patient well-being and inform appropriate design of health services of the community-dwelling older population.