ReviewMultidisciplinary team interventions to optimise health outcomes for older people in acute care settings: A systematic review
Section snippets
Background
A major challenge facing health care systems internationally is managing the increasing numbers of hospitalised older people with chronic and complex conditions (Lim et al., 2013, World Health Organization, 2008). Despite the focus on maintaining and supporting older people to live in the community for as long as possible, hospitalisation for stabilisation and/or management of a range of chronic and complex conditions is frequently indicated (Brereton et al., 2012). Such hospitalisation places
Study criteria
Studies were included if they were (i) a prospective, randomized controlled trial, (ii) tailored team-based interventions addressing specific needs of acute care inpatients aged over 65 years, (iii) tested an intervention implemented by a multidisciplinary team, composed of at least two health disciplines; and (iv) were published in the English language between January 2000 and July 2014. The intervention was defined as any additional package of care, composed of one or more key elements in
Study characteristics
Six studies met the inclusion criteria, each was undertaken in different countries across the developed world: Australia (n = 1), Belgium (n = 1), Finland (n = 1), France (n = 1), Spain (n = 1), and Taiwan (n = 1) (Table 1). The results of one study reported two primary and secondary outcomes were reported in separate publications (Courtney et al., 2009, Courtney et al., 2012), as reflected in Table 1.
A total of four studies measured unplanned readmission as an outcome, although the findings were variable
Discussion
Hospitalization is common in the older person and made more complex by morbid conditions, frailty, poly-pharmacy and the risk of iatrogenesis. Labella, Merel, and Phelan (2011) describe the top ten ways in which to improve care of older people in hospital (1) multifactorial approach to care; (2) screening for common geriatric syndromes; (3) preventing functional decline; (4) screening and prevention of delirium; (5) treating non dementia illnesses in hospitalised elders with dementia requires
Conclusion
This review supports the need for team based interventions for older people in hospital in order to improve care outcomes such as function, independence and activities for daily living. It is essential that components of the CGA that can be implemented by multidisciplinary teams are identified to optimise health outcomes for older people in acute care settings. Refining the roles and responsibilities for health professionals in these models should be an important area for future focus to
Authors’ contributions
LDH—PMD proposed the hypotheses, drafted the manuscript; compiled the tables, data extraction; data analysis and shortlisting of the included studies.
JLP—data extraction and data analysis, compiled the tables, and drafted the manuscript.
PJN—data extraction and data analysis and shortlisting of the included studies, drafted the manuscript.
EH—drafted the manuscript.
AN—compiled the tables.
PMD—proposed the hypotheses and drafted the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
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