Clinical indicators of acute deterioration in persons who reside in residential aged care facilities: A rapid review.
Shirley Chambers, Amy Spooner, Christina Parker and 5 others
PMID 36264005WHAT IT FOUND
Altered consciousness, changed behavior or mood, pain, falls, reduced intake, functional decline and continence change were reported clinical indicators of acute deterioration in residential aged care residents.
Key findings
01The review reported Disability as the largest clinical indicator category, 32% (34/106), including altered level of consciousness, changed behavior and mood, and pain.
02Organization-related factors accounted for more than half of the factors, 56% (29/52), with under-resourcing, care staff skill mix and workload frequently mentioned.
03No included article specifically listed the clinical indicators of acute deterioration; the review extrapolated them from early warning tools, minimum datasets, hospital transfer records, nonspecific symptoms, soft signs and staff opinions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Rapid review methods increase risk of bias because they are less transparent and reproducible, excluded most gray literature, and searched only from 2000. Only English publications and studies from developed countries were included. No included article specifically listed clinical indicators; they were extrapolated from tools, datasets, transfer records, nonspecific symptoms, soft signs and staff opinions. The included research publications were rated less than moderate quality, with median 1.7 and range 0.8 to 2.5 from a possible maximum of 3. Many included studies were single-site, and data from hospital transfers, chart notes and discharge summaries were not collected for research purposes. The narrative synthesis was subjective, and others might interpret the extrapolated findings differently.
Declared interests
The authors declared no conflicts of interest. The funding section names Health Innovation, Investment and Conflict.
The easy way to misread this
Do not read this as evidence that early warning tools prevent hospital transfers in residential aged care. The review identified reported indicators and influencing factors, and the included research publications were rated less than moderate quality.