Table 1 Comprehensive assessment and multi-faceted care interventions for older adults in the ED, by intervention category and level of evidence

Comprehensive assessment and multi-faceted care to improve system performance

Goldberg et al., 2020a, USA [34]

ED LOS (hours), median

5.3

5.0

0.94

II

ne

Discharged to home, n (%)

39/55 (7.9)

35/55 (63.6)

0.58

ne

Discharged to skilled nursing facility, n (%)

6/55 (10.9)

10/55 (18.8)

0.58

ne

Hospital admission, n (%)

10/55 (18.8)

10/55 (18.8)

0.58

ne

Goldberg et al., 2020b, USA [33]

Fall-related ED visits, IRR (95% CI)

0.34 (0.15, 0.76)

NR

II

 + 

All ED visits, IRR (95% CI)

0.47 (0.29, 0.74)

NR

 + 

Fall-related hospital admissions, IRR (95% CI)

0.99 (0.31, 3.27)

NR

ne

All hospital admissions, IRR (95% CI)

0.57 (0.31, 1.04)

NR

ne

Aldeen et al., 2014, USA [42]

Discharge, %

39.2

55.2

NR

III-2

 + 

ED LOS (hours), median (IQR)

5.3 (3.8–7.0)

6.4 (4.9–8.2)

 < 0.001*

-

Inpatient LOS (hours), median (IQR)

90 (48–159)

72 (44–125)

0.07

ne

3-day ED re-presentation, %

2.7

2.5

NS

ne

30-day inpatient readmission, %

17.0

13.2

NS

ne

Arendts et al., 2013, Australia [41]

28-day ED re-attendance, %

14.8

17.9

0.05*

III-2

-

28-day mortality, %

1.3

1.4

0.85

ne

One-year unplanned hospitalisations, %

29.5

43.4

 < 0.001*

-

One-year mortality, %

10.2

10.7

0.66

ne

Beauchet et al., 2021, Canada [39]

ED LOS, β (95% CI)

2.94 (2.00, 3.85)

 < 0.001*

III-2

-

Hospital LOS, β (95% CI)

 − 2.07 (− 3.67, − 0.47)

0.01*

 + 

Hospital admission, OR (95% CI)

0.92 (0.81, 1.04)

0.182

ne

Beauchet et al., 2022, Canada [40]

Hospital admission, OR (95% CI)

 ≤ 0.61 (0.40, 0.93)

0.02*

III-2

 + 

ED LOS, β (95% CI)

4.28 (1.13, 7.43)

 < 0.01*

-

Blomaard et al., 2021a, The Netherlands [38]

Compliance with CGA interventions, n (%)

72/343 (21)

114/363 (31.2)

 < 0.01*

III-2

 + 

ED LOS (min), median (IQR)

202 (133, 290)

196 (133, 265)

0.15

ne

Hospital admission rate, n (%)

362/920 (40.0)

368/953 (38.9)

0.41

ne

Bosetti et al., 2020, France [37]

Hospital admission, OR (95% CI)

1.39 (1.05, 1.85)

0.02*

III-2

-

30-day readmissions, OR (95% CI)

0.65 (0.46, 0.94)

0.02*

 + 

Conroy et al., 2014, UK [36]

Hospital admission (≥ 85 years), n (%; 95% CI)

444/638 (69.6; 66.0, 73.1)

461/753 (61.2; 57.7, 64.7)

 < 0.001*

III-2

 + 

Seven-day readmission (≥ 85 years), n (%); risk ratio (95% CI)

30/638 (4.7); 0.71 (0.42, 1.1)

25/753 (3.3)

NR

ne

30-day readmission (≥ 85 years), n (%; risk ratio)

79/638(12.4); 0.74(0.55, 1.00)

69/753(9.2)

NR

ne

90-day readmission (≥ 85 years), n (%; risk ratio)

166/638 (26.0); 0.77 (0.63, 0.93)

150/753(19.9)

NR

 + 

LOS (≥ 85 years) (days), mean

8.9

11.1

NR

-

Ellis et al., 2012, UK [35]

Same day discharge, n (%)

3/212 (1.4)

36/210 (17.1)

 < 0.001*

III-2

 + 

Direct same day admission to specialty bed, n (%)

149/212 (71)

123/210 (69)

0.02*

-

Hospital LOS (days), mean (SD)

12.2 (18.63)

12.7 (21.01)

0.78

ne

7-day readmission, n (%)

14/212 (6.6)

15/210 (7.1)

0.82

ne

30-day readmission, n (%)

36/212 (17.0)

33/210 (15.7)

0.55

ne

12-month mortality, n (%)

89/212 (42)

76/210 (36.2)

0.23

ne

12-month NH admission, n (%)

19/212 (9.0)

24/210 (11.4)

0.69

ne

12-month living at home, n (%)

104/212 (49.1)

109/210 (51.9)

0.78

ne

Guttman et al., 2004, Canada [43]

Unscheduled revisits at 8-days post-discharge, risk ratio (95% CI)

0.70 (0.44, 1.10)

NR

III-2

ne

Unscheduled revisits at 14-days post-discharge, risk ratio (95% CI)

0.80 (0.55, 1.15)

NR

ne

Satisfaction with the clarity of discharge information, median (interquartile range)

1.5 (1.0, 2.0)

1.7 (1.3, 2.0)

 < 0.001*

 + 

Heeren et al. 2019 Netherlands [32]

ED LOS (hours), median (range)

19.1 (1.3, 110.3)

12.7 (1.4, 61.2)

 < 0.001*

III-2

 + 

Hospital admission, n (%)

532/794 (67.0)

620/886 (70.0)

 < 0.01*

-

30-day unplanned ED readmission, n (%)

93/768 (12.1)

112/857 (13.1)

0.28

ne

Functional decline at 30 days post discharge, n (%)

61/236 (25.9)

52/240 (21.7)

0.04*

 + 

Mortality at 90 days post-discharge, n (%)

49/768 (6.4)

48/857 (5.6)

0.73

ne

Keyes et al., 2014, USA [31]

Hospital admission, relative risk (95% CI)

0.93 (0.89—0.98)

III-2

 + 

30-day ED re-attendance, hazard ratio (95% CI)

1.09 (0.95 to 1.23)

ne

180-day ED re-attendance, hazard ratio (95% CI)

0.99 (0.91 to 1.08)

ne

Liu et al., 2021, Sweden [30]

Discharged home

566/1,743 (32.5)

306/634 (48.3)

0.04*

III-2

 + 

Hospital admission, n (%)

876/1,743 (50.3)

198/634 (31.2)

 < 0.01*

 + 

Transferred to receiving hospital, n (%)

266/1,743 (15.3)

126/634 (19.9)

0.02*

-

ED LOS (minutes), median (95% CI)

313 (304, 320)

390 (378, 407)

 < 0.01*

-

Marsden et al., 2022, Australia [47]

Patients seen in post-GEDI period compared to the pre-GEDI period

III-2

HOSPITAL A

Change in hospital LOS (days), mean (95% CI)

1.39 (1.21, 1.59)

NR

-

Risk of in‑hospital death, prevalence ratio (95% CI)

0.41 (0.24, 0.70)

NR

 + 

Same cause ED representation, hazard ratio (95% CI)

NR

NR

Any cause representation, hazard ratio (95% CI)

0.89 (0.84, 0.95)

NR

 + 

Readmission any reason, hazard ratio (95% CI)

1.07 (0.90, 1.28)

NR

ne

HOSPITAL B

Change in hospital LOS (days), mean (95% CI)

‑0.39 (‑0.54, ‑0.23)

NR

 + 

Risk of in‑hospital death, prevalence ratio (95% CI)

0.66 (0.37, 1.16)

NR

ne

Same cause ED representation, hazard ratio (95% CI)

0.96 (0.87,1.07)

NR

ne

Any cause representation, hazard ratio (95% CI)

0.98 (0.92,1.05)

NR

ne

Readmission any reason, hazard ratio (95% CI)

1.10 (0.88, 1.39)

NR

ne

Patients seen by GEDI compared to those not seen by GEDI in the post-GEDI period

HOSPITAL A

Change in hospital LOS (days), mean (95% CI))

0.63 (0.41, 0.87)

NR

-

Risk of in‑hospital death, prevalence ratio (95% CI)

0.43 (0.15, 0.98)

NR

 + 

Same cause ED representation, hazard ratio (95% CI)

NR

NR

Any cause representation, hazard ratio (95% CI)

1.00 (0.92, 1.09)

NR

ne

Readmission any reason, hazard ratio (95% CI)

1.21 (0.96, 1.53)

NR

ne

HOSPITAL B

Change in hospital LOS (days), mean (95% CI)

‑0.12 (‑0.29, 0.05)

NR

 + 

Risk of in‑hospital death, prevalence ratio (95% CI)

0.84 (0.41, 1.59)

NR

ne

Same cause ED representation, hazard ratio (95% CI)

1.45 (1.29, 1.64)

NR

-

Any cause representation, hazard ratio (95% CI)

1.60 (1.49, 1.73)

NR

-

Readmission any reason, hazard ratio (95% CI)

1.47 (1.14, 1.89)

NR

-

Southerland et al., 2018, UK [48]

Hospital admission

25.7%

25.8%

NS

III-2

ne

LOS in observation (hours), mean (range)

14.3 (1.7, 42.7)

15.3 (1.1, 35.5)

NS

ne

Wallis et al., 2018, Australia [50]

Likelihood of discharge, (Hazard ratio, 95% CI)

1.2 (1.1, 1.2)

NR

III-2

 + 

Reduced ED LOS, (Hazard ratio, 95% CI)

1.3 (1.2, 1.4)

NR

 + 

Reduced hospital LOS, (Hazard ratio, 95% CI)

1.0 (0.9, 1.1)

NR

ne

Risk of death, (Hazard ratio, 95% CI)

1.0 (0.2, 4.4)

NR

ne

28-day ED representation, (Hazard ratio, 95% CI)

1.2 (0.9, 1.5)

NR

ne

Cost savings per ED presentation (AU$), mean (95% CI)

35 (21, 49)

NR

 + 

Cost savings per hospital admission (AU$), mean (95% CI)

1,469 (1,105, 1,834)

NR

 + 

Warburton et al., 2005, Canada [49]

Not screened vs screened as high-risk, received complete referrals

III-2

LOS (days), median

8

6

NR

ne

30-day revisit ED, %

18

16

NR

ne

Hospital admission, %

9

13

NR

ne

30-day revisit ED and/or admission, %

24

21

NR

ne

30-day multiple encounters, %

9

8

NR

ne

Not screened vs screened as high-risk, received partial or no referrals

LOS (days), median

8

8

NR

ne

30-day revisit ED, %

18

21

NR

ne

Hospital admission, %

9

21

NR

-

30-day revisit ED and/or admission, %

24

35

NR

ne

30-day multiple encounters, %

9

9

NR

ne

Not screened vs screened low-risk

LOS (days), median

8

4

NR

ne

30-day revisit ED, %

18

7

NR

ne

Hospital admission, %

9

2

NR

ne

30-day revisit ED and/or admission, %

24

9

NR

ne

Dresden et al., 2020, USA [44]

Readmission during ED visit (average incremental effect)

III-3

Hospital A, % difference (95% CI)

-10.1 (-20.9, 0.8)

NR

ne

Hospital B, % difference (95% CI)

-17.4 (-25.2, -9.6)

 < 0.05*

 + 

Hospital C, % difference (95% CI)

-2.5 (-13.7, 8.8)

NR

ne

ED discharge, but subsequent readmission within 30 days of prior hospitalisation (average incremental effect)

Hospital A, % difference (95% CI)

4.4 (-1.4, 10.3)

NR

ne

Hospital B, % difference (95% CI)

1.2 (-2.3, 4.6)

NR

ne

Hospital C, % difference (95% CI)

3.1 (-3.0, 9.2)

NR

ne

30-day inpatient readmission (average incremental effect)

Hospital A, % difference (95% CI)

-5.6 (-16.3, 5.1)

NR

ne

Hospital B, % difference (95% CI)

-16.2(-24.0, -8.5)

 < 0.05*

 + 

Hospital C, % difference (95% CI)

0.63 (-10, 11.3)

NR

ne

Keene et al., 2022, America [45]

Discharge, % (OR; 95% CI)

29 (2.06; 1.73,2.47)

54

NR

III-3

 + 

ED LOS (hours), mean

4.62

4.94

 < 0.01*

-

Hospital LOS (days), mean

5.54

4.50

 < 0.01*

 + 

Silvester et al., 2014, UK [46]

Reduction in bed occupancy, mean (95% CI)

-20.4 (-39.6, − 1.2)

0.04*

III-3

 + 

In-hospital mortality, % (95% CI); OR (95% CI)

11.4 (10.4, 12.4); 0.8 (0.6, 1.0)

9.15 (7.6, 10.7)

0.06

ne

28-day readmission rate, % (OR; 95% CI)

17.1 (0.9; 0.8, 1.2)

16.3

0.61

ne

Comprehensive assessment and multi-faceted care to improve patient outcomes

Vivanti et al., 2015, Australia [51]

Weight change (kg), mean (SD)

 − 1.1 (4.6)

0.8 (3.7)

NS

II

ne

LOS (days), median (range)

6 (2, 59)

4.5 (1, 60)

NS

ne

EDQ5 quality of life, mean (SD)

0.1 (16.4)

14.4 (29)

NS

ne

Depression (EDQ5), mean (SD)

1.4 (6.9)

0.9 (3.0)

NS

ne

Further decline in nutritional status, n (%)

0/9 (0)

1/10 (10)

NS

ne

Huded et al., 2022, USA [53]

Consults to pharmacy, n (%)

195/725 (26.9)

315/725 (43.4)

 < 0.001*

III-2

 + 

Consults to social work, n (%)

132/725 (18.2)

399/725 (55.0)

 < 0.001*

 + 

Referrals to Geriatrics, n (%)

18/725 (5.8)

64/725 (17.7)

 < 0.001*

 + 

Referrals to Home Based Primary Care, n (%)

24/725 (7.8)

110/725 (30.4)

 < 0.001*

 + 

Hospital admission, n (%)

417/725 (57.5)

363/725 (50.1)

 < 0.01*

 + 

30-day hospital admissions, n (%)

464/725 (64.0)

412/725 (56.8)

 < 0.001*

 + 

ED LOS (hours), n (%)

5.4/725 (2.6)

5.4/725 (2.2)

0.85

ne

72-h ED representations, n (%)

16/725 (2.2)

23/725 (3.2)

0.25

ne

Hullick et al., 2018, Australia [52]

Screening of cognition, n (%)

1/63 (1.5)

24/63 (38)

 < 0.001*

III-2

 + 

Review of pain, n (%)

18/63 (29)

47/63 (75)

 < 0.001*

 + 

Given food or fluids, n (%)

8/63 (13)

31/63 (49)

 < 0.001*

 + 

Orientation, n (%)

0/63 (0)

32/63 (51)

 < 0.001*

 + 

Toileting, n (%)

0/63 (0)

21/63 (33)

 < 0.001*

 + 

Mobilisation, n (%)

0/63 (0)

26/63 (41)

 < 0.001*

 + 

Pressure care, n (%)

3/63 (4.8)

19/63 (30)

 < 0.001*

 + 

ED LOS (minutes), mean (SD)

412 (257)

524 (278)

NR

-

Discharged from ED, n (%)

5,660/8,287 (68)

1,161/4563 (25)

NR

-

Admitted to hospital, n (%)

2,627/8,287 (32)

3,402/4563 (75)

NR

-

Clinicians’ experiences of the OPTA role

Mixed responses and support for the OPTA role

 ± 

30-day multiple encounters, %

9

2

NR

ne

Lee et al., 2001, Canada [55]

Discharged home vs admitted to hospital

III-3

Lives with others, %

22.5

7.5

0.4

SMAF disability score, mean

16.6

25.4

 < 0.01*

SMAF handicap score, mean

6.3

12.6

 < 0.001*

Ngian et al., 2008, Australia [54]

Documentation of pre-morbid:

IV

Functional impairment, n (%)

49/103 (48)

68/103 (66)

 < 0.01*

 + 

Cognitive impairment, n (%)

30/103 (29)

73/103 (71)

 < 0.01*

 + 

Mobility impairment, n (%)

46/103 (45)

85/103 (83)

 < 0.01*

 + 

Documentation and assessment at presentation for:

Functional impairment, n (%)

1/103 (1)

36/103 (36)

 < 0.01*

 + 

Cognitive impairment, n (%)

22/103 (21)

70/103 (68)

 < 0.01*

 + 

Mobility impairment, n (%)

9/103 (9)

52/103 (51)

 < 0.01*

 + 

Comprehensive assessment and multi-faceted care to improve patient experience

Corbett et al., 2005, Australia [56]

Hospital admission, n (%)

8,170/40,510 (20.2)

8,699/48,238 (18.0)

 < 0.01*

III-2

 + 

AQoL social relationships score, mean (SD)

0.6 (0.3)

0.9 (0.1)

 < 0.01*

 + 

AQoL Psychological wellbeing score, mean (SD)

0.6 (0.3)

0.9 (0.1)

 < 0.01*

 + 

AQoL utility score, mean (SD)

0.3 (0.2)

0.6 (0.2)

 < 0.01*

 + 

Argento et al., 2014, USA [57]

ED LOS (minutes), mean

401

360

NR

III-3

 + 

Discharge time (minutes), mean

302

258

NR

 + 

Patient satisfaction, mean

69.9

93.8

NR

 + 

McGrath et al., 2019, UK [59]

 > 75 years presenting to ED by ambulance

III-3

Clinical Frailty Scale completed, %

73

NR

 + 

 > 75 years attending ED through any route

Clinical Frailty Scale completed, %

47

NR

ne

Hospital admission

50.7

49.2

NR

ne

Staff satisfaction survey

Felt confident about using the Rockwood CFS, n (%)

17/22 (77)

NR

 + 

Felt the frailty team was beneficial to patient flow through ED, n (%)

22/22 (100)

NR

 + 

Patient satisfaction

Happy with the experience of the frailty pathway, n (%)

9/10 (90)

NR

 + 

Feeling the additional time spent to complete a CGA was acceptable, n (%)

8/10 (80)

NR

 + 

Experience as better or the same as any previous ED attendance, n (%)

10/10 (100)

NR

 + 

Palonen et al., 2015, Finland [58]

Pre-discharge confidence

IV

Did not need more information, OR (95% CI)

2.7 (1.0, 7.5)

0.05

ne

No worries after discharge

Did not need more information, OR (95% CI)

4.8 (1.9, 11.8)

0.001*

 + 

No unexpected problems after discharge

Did not need more information, OR (95% CI)

3.8 (1.5, 9.6)

 < 0.01*

 + 

Overall readiness two weeks after discharge

Did not need more information, OR (95% CI)

10.4 (3.7, 29.2)

 < 0.001*

 + 

Received discharge education

3.7 (1.3, 10.3)

0.01*

 + 

Blomaard et al., 2021b, The Netherlands [60]

Recall of screening administration

Noticed little of the screening administration during triage and screening was considered as a normal part of ED care

N/A

 + 

Experienced consequences of screening

None of the participants had a negative attitude towards screening or thought that screening is age discrimination

 + 

Added value of screening

Most participants believed that geriatric screening contributes to assessing older adults holistically, recognising geriatric problems early and comforting patients with communication and attention

 + 

Comprehensive assessment and multi-faceted care to improve staff experience

O'Grady et al., 1996, Australia [61]

ED LOS

Not impacted

N/A

ne

Likely admissions avoided, %

33

 + 

Waiting time

Not impacted

ne

LOS

Not impacted

ne

Patient satisfaction, %

85

 + 

GPs satisfied with the Quick Response Program concept, %

79

 + 

GPs satisfied with arrangements made for their Quick Response Program patients, %

71

 +