A scoping review of end-of-life care provided for older adults presenting to the emergency department

Dr Ya-Ling Huang1, Dr Nemat  Alsaba1, Ms Gemma Brookes2, Prof Julia Crilly1,2,3

1Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Australia, 2School of Nursing, Griffith University, Southport, Australia, 3Menzies Health Institute Queensland, Griffith University, Southport, Australia

Background: Older people are increasingly utilising emergency services with 22% of the eight million emergency department (ED) presentations in the 2017-18 financial year made by people aged ≥ 65.  Some present to the ED with trajectories of dying.

Aim: This scoping review aimed to provide a comprehensive understanding of available research regarding end-of-life (EOL) care for older adults in the ED.

Methods: The review was guided by Joanna Briggs Institute scoping review methodology. Four databases including CINAHL, Ovid MEDLINE, Embase, SocINDEX and Google Scholar were searched. The search was limited to articles published in English between 2007 and 2018. A combination of terms, such as older/aged/geriatrics/elderly, palliative/terminal/end-of-life and emergency/emergency service, was used.

Results: Fourteen articles were included. Definitions vary regarding what EOL care is in the ED.  The profile of older people who present to the ED and require EOL care indicates them to be mostly female, triaged in urgent or semi-urgent category, present with diagnosis of cardiac and pulmonary disease, advanced cancer and dementia. Multiple EOL tools exist regarding predicted mortality, assessment of functional status, comorbidities, symptom distress, palliative care needs, quality of life and caregiver’s stress. Interventions to optimise care delivery for older adults at EOL in the ED included: 1) Geriatric Emergency Department Innovation program; 2) rapid standardised two-stage screening protocol; and 3) pilot palliative care program. Outcomes reported included lower admission rates, shorter ED length of stay, increased palliative care consultations and referrals. The NHMRC level of evidence level of included studies ranged from II to IV.

Conclusions: This review provides an overview of empirical evidence of EOL care for older people presenting to ED. Information was limited and inconsistent regarding defining EOL care, clinical profile, care delivery and outcomes. Future research and clinical practice that uses current evidenced-based policies and guidelines is required.


Biography:

Dr Ya-Ling Huang completed her Master’s degree and PhD degree at Queensland University of Technology (QUT) with a focus on palliative and end-of-life care. She is working as a clinician and as a research nurse in emergency medicine (ED) research at Gold Coast University Hospital. Clinically speaking, she has had work experience in different areas, i.e. palliative care, acute care, oncology and geriatrics. She has also worked in research at Institute of Health and Biomedical Innovation (IHBI), QUT and Centre for Online Health and Centre for Research in Geriatric Medicine, School of Medicine, University of Queensland.