Efficacy of interventions led by staff with geriatrics expertise in reducing hospitalisation in nursing home residents: A systematic review

Abstract

Objective: To determine the efficacy of interventions, delivered by geriatrics-trained staff for nursing home residents, in reducing hospitalisation. Methods: Multiple databases and clinical trial registers were searched. Studies that provided comparative data and involved residents aged ≥65 years evaluating patient-level interventions delivered by geriatrics-trained staff were included. The systematic review protocol was made available on PROSPERO (registration number CRD42017079928; www.crd.york.ac.uk/PROSPERO). Results: Sixteen studies were included; six were randomised controlled trials. Studies were categorised according to intervention approaches into the following: (i) hospital prevention program; (ii) emergency department-based hospital avoidance program; and (iii) post-hospital supported discharge program. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality of evidence was low to moderate. Most studies demonstrated a favourable trend; however, only a few reported statistically significant reductions in hospitalisations. Results from the randomised studies were non-significant. Conclusions: Despite the heterogeneity of studies, there is limited evidence that interventions delivered by geriatrics-trained staff reduce hospitalisations in nursing home residents. Further work examining decision-making around hospital transfer may help inform future intervention design.