Elsevier

Archives of Gerontology and Geriatrics

Volume 61, Issue 3, November–December 2015, Pages 322-329
Archives of Gerontology and Geriatrics

Review
Multidisciplinary team interventions to optimise health outcomes for older people in acute care settings: A systematic review

https://doi.org/10.1016/j.archger.2015.06.021Get rights and content

Highlights

  • All of the reported studies aimed to describe complex multifaceted interventions.

  • Challenges lies in accurate and detailed reporting of complex interventions to allow for replication and true understanding.

  • Older people need team based interventions in order to improve care outcomes such as function, independence and activities for daily living.

  • Components of the CGA that can be implemented by multidisciplinary teams should be identified to optimise health outcomes.

  • Refining the roles and responsibilities for health professionals in these models should be an important area for future focus.

Abstract

Background

A major challenge facing our health care systems internationally is managing the needs of increasing numbers of older people in hospital with chronic and complex conditions. A multidisciplinary approach is considered central to tailoring and targeting approaches to gerontological care, although this is often not realised in reality. Comprehensive geriatric assessment (CGA) is seen as gold standard, though they are not readily available in many acute settings, compounded by the requirement for time, coordination of multidisciplinary specialties, and reimbursement issues. This systematic review aimed to identify multidisciplinary team interventions to optimise health outcomes for older people in acute care settings.

Method

Systematic review of randomised controlled trials reporting acute care multidisciplinary team based interventions, to improve care outcomes for hospitalised older people. Electronic databases (MEDLINE, CINAHL (EBSCO), Cochrane and PsycINFO) were searched from 1 January 2000 to 1 July 2014 in the English language. Data was extracted by two reviewers and checked by a third reviewer to resolve any conflicts.

Results

Seven articles reporting RCTs met the systematic review inclusion criteria. The heterogeneity of study populations, multidisciplinary team interventions and outcome measures necessitated the use of narrative analysis. Three common elements of these studies included: (i) tailored treatment by clinicians with geriatric expertise (ii) a focus on transitional care interventions that enhance discharge planning; and (iii) communication an essential ingredient to improving care.

Conclusion

The tailoring of treatment, underpinned with clear communication strategies can reduce emergency department re-admission rates, mortality and functional decline of older people. Refining health professionals roles and responsibilities within transition models is an essential component that can improve health outcomes for older people in acute care settings.

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.

References (31)

  • A.J. de Vos et al.

    Integrated approach to prevent functional decline in hospitalized elderly: the Prevention and Reactivation Care Program (PReCaP)

    BMC Geriatrics

    (2012)
  • O. Dalleur et al.

    Reduction of potentially inappropriate medications using the STOPP criteria in frail older inpatients: a randomised controlled study

    Drugs & Aging

    (2014)
  • M. Deschodt et al.

    Impact of geriatric consultation teams on clinical outcome in acute hospitals: a systematic review and meta-analysis

    BMC Medicine

    (2013)
  • G. Ellis et al.

    Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials

    BMJ

    (2011)
  • B. Elsawy et al.

    The geriatric assessment

    American Family Physician

    (2011)
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