The Effectiveness Of Nurse- Interventions To Reduce Adverse Outcomes Among Older Patients Following Emergency Department Discharge A Systematic Review

Abstract

Older adults discharged from the Emergency Department (ED) are at increased risk of adverse outcomes such as hospital readmissions, functional decline, and falls. Nurse-led interventions have been proposed as a promising approach to mitigate these risks and improve post-discharge care for older patients. However, the effectiveness of nurse-led interventions in this context remains unclear due to heterogeneity in study designs and outcomes assessed. A systematic review was conducted to evaluate the effectiveness of nurse-led interventions in reducing adverse[1] outcomes among older patients following ED discharge. Electronic databases including PubMed, Embase, and Cochrane Library were searched for relevant studies published up to 2024. Studies meeting predefined inclusion criteria were selected, and data were extracted using a standardized form. The methodological quality of included studies was assessed, and a narrative synthesis approach was employed to summarize findings. A total of 29 studies were included in the review, encompassing various nurse-led interventions targeting older adults following ED discharge. Interventions ranged from comprehensive geriatric assessments to transitional care programs, falls prevention initiatives, and self-management empowerment programs. Outcomes assessed included hospital readmissions, functional decline, falls, healthcare utilization, and patient satisfaction. Findings were mixed, with some studies demonstrating positive effects of nurse-led interventions on reducing hospital readmissions, improving functional outcomes, and enhancing patient satisfaction, while others reported null findings. Heterogeneity in study designs, intervention components, and outcome measures limited the ability to conduct meta-analysis. Nurse-led interventions hold promise in improving outcomes for older adults following ED discharge, but their effectiveness remains uncertain due to the variability in study methodologies and outcomes assessed.