Carole Ratsimbazafy1, Camille Schwab2, Agnès Dechartres3, Christine Fernandez2, Patrick Hindlet2. 1. GHU AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Pharmacie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France. Electronic address: c-ratsimbazafy@hotmail.fr. 2. GHU AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Pharmacie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Université Paris-Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Chatenay Malabry, France. 3. Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GHU AP-HP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Biostatistiques santé publique information médicale, Paris, France.
Abstract
OBJECTIVES: Falls are an important issue in older adults as they are frequent, deleterious, and often lead to repeated consultations at the emergency department (ED) and unplanned hospitalizations. Our principal objective was to provide an inventory of interventions designed to prevent unplanned readmissions or ED visits of older patients presenting to hospital with a fall. DESIGN: Systematic review performed on February 11, 2019 in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science, without date or language restriction. We manually updated this search in August 1, 2019. Study selection, data extraction and risk of bias assessment were conducted independently by 2 reviewers. SETTING AND PARTICIPANTS: We included studies reporting interventions to prevent unplanned readmissions or ED visits of older patients (aged 65 years or over) presenting to hospital because of a fall. RESULTS: We identified 475 unique citations after removing duplicates and included 6 studies (2 observational and 4 interventional studies). The studies were published between 2012 and 2019; they evaluated heterogeneous interventions that were frequently multifaceted and multidisciplinary. The interventions were shown effective in reducing readmissions or ED revisits compared with control groups in 3 studies (relative risk reductions between 30% and 65%), all of which were multifaceted and 2/3 multidisciplinary. CONCLUSIONS AND IMPLICATIONS: With 6 articles showing inconsistent results, our study highlights the need to adequately design and evaluate interventions to reduce the burden of hospital readmissions among older fallers. Retrieved studies are recent, which underlines that hospital readmissions are a current concern for researchers and public health authorities [PROSPERO registration number: CRD42019131965].
OBJECTIVES: Falls are an important issue in older adults as they are frequent, deleterious, and often lead to repeated consultations at the emergency department (ED) and unplanned hospitalizations. Our principal objective was to provide an inventory of interventions designed to prevent unplanned readmissions or ED visits of older patients presenting to hospital with a fall. DESIGN: Systematic review performed on February 11, 2019 in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science, without date or language restriction. We manually updated this search in August 1, 2019. Study selection, data extraction and risk of bias assessment were conducted independently by 2 reviewers. SETTING AND PARTICIPANTS: We included studies reporting interventions to prevent unplanned readmissions or ED visits of older patients (aged 65 years or over) presenting to hospital because of a fall. RESULTS: We identified 475 unique citations after removing duplicates and included 6 studies (2 observational and 4 interventional studies). The studies were published between 2012 and 2019; they evaluated heterogeneous interventions that were frequently multifaceted and multidisciplinary. The interventions were shown effective in reducing readmissions or ED revisits compared with control groups in 3 studies (relative risk reductions between 30% and 65%), all of which were multifaceted and 2/3 multidisciplinary. CONCLUSIONS AND IMPLICATIONS: With 6 articles showing inconsistent results, our study highlights the need to adequately design and evaluate interventions to reduce the burden of hospital readmissions among older fallers. Retrieved studies are recent, which underlines that hospital readmissions are a current concern for researchers and public health authorities [PROSPERO registration number: CRD42019131965].