A systematic review of reasons and risks for acute service use by older adult residents of long-term care.
Eamon Merrick, Katherine Bloomfield, Christopher Seplaki and 8 others
PMID 38616544WHAT IT FOUND
Older long-term care residents often move to hospital or emergency care in their first year, with respiratory problems, cardiovascular disease, falls, frailty, poor function and medication burden commonly involved.
These are warning signs, not proof that checking them prevents admission.
Key findings
01Transitions to acute care were more likely in the first year of long-term care residence.
02Respiratory symptoms and conditions were the most frequently reported medical reasons for hospital or emergency use.
03Taking 10 or more medications was associated with a relative risk ratio of 1.94 for acute hospital admission compared with 4 or fewer.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review could not combine studies statistically because they measured different outcomes and used different effect measures. Most included studies were observational and used retrospective medical or administrative records, so they show associations rather than cause. Many studies lacked a comparable control cohort, and 13 did not adequately describe follow-up or loss to follow-up. Some studies relied on self-report for outcomes, and the authors had only 70% agreement when classifying conditions. The search terms may have missed important influences such as staffing levels and attitudes, facility structure or ownership, hospice or palliative care support, and family preferences. Evidence was inconsistent for age, cognitive impairment and antipsychotic medications, so those findings should not be read as settled.
Declared interests
The review itself received no funding and the authors declared no conflicts of interest. The included studies had varied funding, including from pharmaceutical companies and aged-care or health service providers, and some authors reported commercial interests or employment by a funder.
The easy way to misread this
Do not read these risk factors as proof that early assessment or medication review prevents hospitalisation. The review reports associations from mostly observational studies, could not combine results statistically, and the authors say causal pathways remain unclear.