Marincowitz, C. orcid.org/0000-0003-3043-7564, Preston, L. orcid.org/0000-0001-7477-4517, Cantrell, A. orcid.org/0000-0003-0040-9853 et al. (3 more authors) (2022) What influences decisions to transfer older care-home residents to the emergency department? A synthesis of qualitative reviews. Age and Ageing, 51 (11). afac257. ISSN 0002-0729
Abstract
Background
care home residents aged over 65 have disproportionate rates of emergency department (ED) attendance and hospitalisation. Around 40% attendances may be avoidable, and hospitalisation is associated with harms. We synthesised the evidence available in qualitative systematic reviews of different stakeholders’ experiences of decisions to transfer residents to the ED.
Methods
six electronic databases, references and citations of included reviews and relevant policy documents were searched. Reviews of qualitative studies exploring factors that influenced care home staff, medical practitioners, residents’ family or residents’ experiences and factors influencing decisions to transfer residents to the ED were included. Thematic analysis was used to synthesise findings.
Results
six previous reviews were included, which synthesised the findings of 34 primary studies encompassing 152 care home residents, 283 resident family members or carers and 447 care home staff. Of the primary studies, 19 were conducted in the North America, seven in Australia, five were conducted in Scandinavia, two in the United Kingdom and one in Holland. Three themes were identified: (i) power dynamics between residents, family members, care home staff and health care professionals (external to the care home) influence decisions; (ii) admission can be necessary; however, (iii) some decisions may be driven by factors other than clinical need.
Conclusion
transfer decisions are complex and are determined not just by changes in health status interventions aimed at reducing avoidable transfers need to address the key role family members have in transfer decisions, the medical legal fears of care home staff and barriers to accessing community services.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial Licence (https://creativecommons.org/licenses/by-nc/4.0/) |
Keywords: | care homes; systematic review; qualitative research; older people |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number DEPARTMENT OF HEALTH AND SOCIAL CARE NIHR200166 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 20 Dec 2022 15:07 |
Last Modified: | 20 Dec 2022 15:07 |
Status: | Published |
Publisher: | Oxford University Press (OUP) |
Refereed: | Yes |
Identification Number: | 10.1093/ageing/afac257 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:194495 |