173 Summary of performed studies CHAPTER 8 In this chapter, we provide a summary of the studies we performed within this thesis. In Chapter 1, we provided background on older adults in society and in the emergency department (ED). We described the specific problems of older adults presenting to EDs and provided data showing the magnitude of ageing and its impact on EDs and the quality of care delivered for older adults in the ED. We also described the relationship between crowding, ED length of stay and poor outcomes of older adults presenting to the ED. The chapter provided an overview of the literature showing interventions – including geriatric emergencymedicine education of emergency physicians – to improve care for older adults in the ED. The chapter concluded with the aims and outline of the thesis. Chapter 2 described the results of our study, which identified risk factors for prolonged length of stay in the ED for older adults. In this retrospective clinical database study, we analysed the medical records of 2000 patients aged ≥70 years presenting to the ED. Prolonged length of stay was defined as length of stay above the 75th percentile in our ED. Risk factors for prolonged length of stay in the ED for older adults were as follows: higher number (more than one) of consultations or diagnostic interventions; complaints with a neurological or internal medicine focus; altered consciousness; treatment by physicians of the departments of surgery, internal medicine, or pulmonology; and urgency category of ≥ U1. These findings indicate that patient, organizational, and clinical characteristics are important factors in prolonged length of stay and provide input for strategies to prevent prolonged length of stay in the ED for older adults. In chapter 3, we presented the results of our systematic review examining the effectiveness of interventions to alleviate emergency department crowding by older adults. Six biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017, and the effect of interventions for older adults on ED crowding-related outcomes was assessed. After screening of the title and abstract, review of the included studies, and snowballing, 16 studies were considered relevant and underwent full analysis. We identified two effective interventions for alleviating ED crowding. First, the establishment of an “acute frailty zone” within the ED – with early access to geriatrician-led multidisciplinary care – reduces the length of stay of older adults in the ED. Second; older adults treated by an ED-embedded geriatrician receive more timely geriatric assessment. Although these findings could help clinicians and ED managers reorganize ED care processes, our meta-analysis revealed a high risk of bias in the included studies, heterogeneity of the treatment effect, differences in follow-up periods, and the multicomponent characteristics of the studied interventions. Given these limitations of the studies reviewed,
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