Older patients with complex care needs and limited personal and social resources are heavy users of emergency department (ED) services and are often admitted when they present to the ED. Updated information is needed regarding the most effective strategies to appropriately avoid ED presentation and hospital admission among older patients.

This systematic review aimed to identify interventions that have demonstrated effectiveness in decreasing ED use and hospital admissions in older patients. We conducted a comprehensive literature search within Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials from database inception to July 2019 with no language restrictions. Interventional study designs conducted in populations of 65 years and older were included. Primary outcomes were ED visits and hospital admissions. Secondary outcomes included hospital readmission, mortality, cost, and patient-reported outcomes.

Of 7,943 citations reviewed for eligibility, 53 studies were included in our qualitative synthesis, including 26 randomized controlled trials (RCT), 8 cluster-RCTs, and 19 controlled before-after studies. Data characterization revealed that community-based strategies reduced ED visits, particularly those that included comprehensive geriatric assessments and home visits. These strategies reported decreases in mean ED use (for interventions versus controls) ranging from -0.12 to -1.32 visits/patient. Interventions that included home visits also showed reductions in hospital admissions ranging from -6% to -14%. There was, however, considerable variability across individual studies with respect to outcome reporting, statistical analyses, and risk of bias, which limited our ability to further quantify the effect of these interventions.

Various interventional strategies to avoid ED presentations and hospital admissions for older patients have been studied. While models of care that include comprehensive geriatric assessments and home visits may reduce acute care utilization, the standardization of outcome measures is needed to further delineate which parts of these complex interventions are contributing to efficacy. The potential effects of multidisciplinary team composition on patient outcomes also warrant further investigation.

The present study was conducted to determine the impact of a community-based intervention on the nutritional behaviour of a representative sample of Iranian adults.

The Isfahan Healthy Heart Programme (IHHP), a six-year, action-oriented, integrated community-based study aimed at health promotion through the reduction of CVD risk factors, targeted the whole population living in two intervention cities, and compared outcomes with the population of a non-intervention city considered as reference. Dietary interventions were performed as educational, environmental and/or legislative strategies. A global dietary index (GDI) was calculated representing the general dietary behaviour. In addition, two consumption indices were calculated for specific food groups, i.e. meat products and major sources of fat. Univariate AVOVA was conducted to evaluate the impact of the intervention on dietary behaviours.

Isfahan and Najaf-Abad (intervention cities) and Arak (reference city), central Iran.

The baseline survey was conducted among 12514 randomly selected adults aged ≥19 years in both intervention and reference areas. The survey was repeated annually among about 5000 persons (2002–2005) in the intervention and reference communities.

According to significant year × group interactions in mean fat consumption index (FCI) and meat consumption index (MCI) in the total population, a significant improvement in FCI and MCI was found in the intervention areas v. the reference area (P < 0·001). In addition, the GDI improved significantly in the intervention areas v. the reference area (P < 0·001).

The IHHP interventions were effective in improving dietary behaviours at the population level. The highest effectiveness was documented in the change in the type of fat consumed. Such simple and integrated interventions can be adopted in other developing countries with limited financial resources.