Impact of interventions to improve recovery of older adults following planned hospital admission on quality-of-life following discharge: linked-evidence synthesis

• Published in: Health and social care delivery research 2023-11, Vol.11 (23), p.1-164
• Main Authors: Kinsey, Debbie, Febrey, Samantha, Briscoe, Simon, Kneale, Dylan, Thompson Coon, Jo, Carrieri, Daniele, Lovegrove, Christopher, McGrath, John, Hemsley, Anthony, Melendez-Torres, GJ, Shaw, Liz, Nunns, Michael
• Format: Article
• Language: English
• Subjects: effectiveness; elderly; enhanced recovery; length of stay; logic model; mixed-methods systematic review; qualitative comparative analysis; qualitative systematic review; quantitative systematic review
• ISSN: 2755-0060; 2755-0079
• DOI: 10.3310/GHTY5117

Objectives To understand the impact of multicomponent interventions to improve recovery of older adults following planned hospital treatment, we conducted two systematic reviews, one of quantitative and one of qualitative evidence, and an overarching synthesis. These aimed to: understand the effect of multicomponent interventions which aim to enhance recovery and/or reduce length of stay on patient-reported outcomes and health and social care utilisation understand the experiences of patients, carers and staff involved in the delivery of interventions understand how different aspects of the content and delivery of interventions may influence patient outcomes. Review methods We searched bibliographic databases including MEDLINE ALL, Embase and the Health Management Information Consortium, CENTRAL, and Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database, conducted forward and backward citation searching and examined reference lists of topically similar qualitative reviews. Bibliographic database searches were completed in May/June 2021 and updated in April 2022. We sought primary research from high-income countries regarding hospital inpatients with a mean/median age of minimum 60 years, undergoing planned surgery. Patients experienced any multicomponent hospital-based intervention to reduce length of stay or improve recovery. Quantitative outcomes included length of stay and any patient-reported outcome or experience or service utilisation measure. Qualitative research focused on the experiences of patients, carers/family and staff of interventions received. Quality appraisal was undertaken using the Effective Public Health Practice Project Quality Assessment Tool or an adapted version of the Wallace checklist. We used random-effects meta-analysis to synthesise quantitative data where appropriate, meta-ethnography for qualitative studies and qualitative comparative analysis for the overarching synthesis. Results Quantitative review: Included 125 papers. Forty-nine studies met criteria for further synthesis. Enhanced recovery protocols resulted in improvements to length of stay, without detriment to other outcomes, with minimal improvement in patient-reported outcome measures for patients admitted for lower-limb or colorectal surgery. Qualitative review: Included 43 papers, 35 of which were prioritised for synthesis. We identified six themes: ‘Home as preferred environment for recovery’, ‘Feeling safe’, ‘In