Decision-Making for Older Patients in Acute Prehospital Situations: A Scoping Review.
Anders Sterner, Bodil Holmberg, Anders Bremer and 3 others
PMID 41168106WHAT IT FOUND
For older patients needing urgent care outside hospital, transfer decisions are shaped by staff confidence, hierarchy, fear of blame and what family or carers know, not just clinical signs.
Key findings
01In acute prehospital care, older patients' decision-making capacity was described as assessed through conversation, observation and information from people who know the patient.
02Hierarchical structures and fear of consequences were reported to distort decisions, sometimes leading to persuasion or self-protective actions rather than following the patient's expressed wishes.
03Care plans, accessible documentation and access to higher medical expertise were reported to support decisions, while lack of relevant competence was reported alongside more transport decisions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
All included studies came from high-income countries, so the findings may not apply in other health systems. The search was limited to English-language peer-reviewed articles, so relevant non-English or grey literature may be missing. The review protocol was not registered, which reduces transparency about how the search and selection were planned. The review maps concepts and factors; it does not test whether any approach improves patient outcomes. The included studies used different designs, settings and professional groups, so the findings are broad and cannot guide a single clinical protocol.
Declared interests
The authors declare no conflicts of interest. The work was funded by Familjen Kamprads Stiftelse.
The easy way to misread this
Do not read this as evidence that a specific decision tool or training reduces unnecessary hospital transfers. The review maps themes and factors; it does not test whether changing them improves patient outcomes.