A comprehensive systematic review of age-friendly nursing interventions in the management of older people in emergency departments.

Abstract

BACKGROUND The growing demand on health services due to an ageing population and people living with complex chronic illnesses necessitates an integrated and evidence based care approach. In times of acute illness, trauma or difficult life situations, for many older people the Emergency Department is the first port of call. Despite the benefits of presenting to the Emergency Department, this environment can also be challenging for the older person, particularly those who are frail and have cognitive impairments. Emergency Department nurses play a pivotal role in tailoring the care of the older patient that specifically meets their needs, enhances their level of comfort and decreases the risk of additional distress unrelated to their presenting illness. OBJECTIVES The objective of this systematic review was to determine the best available evidence in relation to age-friendly nursing interventions in the management of older people presenting to the Emergency Department. INCLUSION CRITERIA Participants considered for this systematic review included older people aged over 65 who were cared for in the Emergency DepartmentNurse led interventions that enhanced older people's comfort during their stay in Emergency Department, specifically in relation to nutrition, hydration, pressure area care, pain management and communication.Studies using quantitative research methods as well as opinion based papers were considered for this systematic review.Outcomes were assessed in relation to the effectiveness of nursing interventions on pressure area status, hydration status, nutritional status and pain status measured during their stay in the Emergency Department. The text and opinion part of the review focused on the recommended policies for age-friendly nursing interventions. SEARCH STRATEGY An extensive search of the literature was undertaken to retrieve any English language material published and unpublished materials between January 1999 to October 2010. METHODOLOGICAL QUALITY All included articles were assessed by two independent reviewers using the appropriate critical appraisal instruments from the Joanna Briggs Institute. DATA COLLECTION Data were extracted from included papers using data extraction tools developed by the Joanna Briggs Institute. DATA SYNTHESIS Data were synthesised and pooled according to their methodological approach, using standardised JBI instruments. Due to the methodological diversity and limited data found, quantitative data were combined in narrative summary. A meta-synthesis was undertaken for the opinion based data. RESULTS A total of 16 papers were included in the review, two research articles, seven expert opinion and another seven policy documents. This resulted in the identification of 39 findings, which were grouped into seven categories, which were further aggregated into two synthesised findings. CONCLUSIONS There is little high quality research in relation to effective nursing interventions in the management of older people in the Emergency Department. Identified strategies and interventions are predominately based on suggested practices, rather than based in rigorous research. This provides limited guidance to nurses working in ED Departments; however the expert opinion and other literature in this review strongly suggests that a focus on fundamental nursing interventions such as attention to skin integrity, nutrition and hydration, mobility, comfort, falls prevention and social support are important. IMPLICATIONS FOR RESEARCH/PRACTICE Future research is urgently needed to identify the nursing needs of older people in the Emergency Department, and to evaluate the efficacy of nursing interventions to enhance outcomes for older people during and beyond their hospital stay.