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To identify the reasons and/or risk factors for hospital admission and/or emergency department attendance for older (≥60 years) residents of long-term care facilities.
Older adults' use of acute services is associated with significant financial and social costs. A global understanding of the reasons for the use of acute services may allow for early identification and intervention, avoid clinical deterioration, reduce the demand for health services and improve quality of life.
Systematic review registered in PROSPERO (CRD42022326964) and reported following PRISMA guidelines.
The search strategy was developed in consultation with an academic librarian. The strategy used MeSH terms and relevant keywords. Articles published since 2017 in English were eligible for inclusion. CINAHL, MEDLINE, Scopus and Web of Science Core Collection were searched (11/08/22). Title, abstract, and full texts were screened against the inclusion/exclusion criteria; data extraction was performed two blinded reviewers. Quality of evidence was assessed using the NewCastle Ottawa Scale (NOS).
Thirty-nine articles were eligible and included in this review; included research was assessed as high-quality with a low risk of bias. Hospital admission was reported as most likely to occur during the first year of residence in long-term care. Respiratory and cardiovascular diagnoses were frequently associated with acute services use. Frailty, hypotensive medications, falls and inadequate nutrition were associated with unplanned service use.
Modifiable risks have been identified that may act as a trigger for assessment and be amenable to early intervention. Coordinated intervention may have significant individual, social and economic benefits.
This review has identified several modifiable reasons for acute service use by older adults. Early and coordinated intervention may reduce the risk of hospital admission and/or emergency department.
This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.
No patient or public contribution.
To identify and synthesise evidence related to ageism in older regulated nurses' practice settings.
A systematic review following Joanna Briggs Institute methodology.
The review included empirical studies that involved older nurses as the primary study population and studies that focused on ageism in older nurses' work environments, including strategies or interventions to address ageism within the workplace. Following the initial screening, all relevant studies were critically appraised by two reviewers to ensure they were appropriate to include in the review. A synthesis without meta-analysis reporting (SWiM) guideline was employed in the review.
Medical Literature Analysis and Retrieval Systems Online, Scopus, Psychological Information Database and Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched to identify empirical studies and a range of academic institutional websites were accessed for master's and doctoral dissertations and theses. The search covered the period from January 2022 to May 2022, and only publications in English from 2000 onwards were considered.
Nineteen studies were included, ten qualitative studies, seven quantitative studies and two mixed methods secondary analyses. Our results revealed that negative perceptions and beliefs about older nurses' competencies and skills prevail in their practice settings, which influences older nurses' health and well-being as well as their continuation of practice. Further, older nurses' continuation of practice can be facilitated by having a positive personal outlook on ageing, meaningful relationships in their practice settings and working in an environment that is age-inclusive.
To combat ageism in older nurses' practice settings and support their continuation of practice, effective interventions should be organisational-led. The interventions should focus on fostering meaningful relationships between older nurses and their colleagues and managers. Further, healthcare institutions should implement initiatives to promote an age-inclusive work environment that supports an age-diverse nursing workforce.
The review findings offer insights for healthcare managers, policymakers and researchers, emphasising the need for anti-ageism policies in healthcare organisations. According to WHO (2021), educational activities such as role-playing and simulation during in-service training may also be effective interventions. Additionally, incorporating anti-ageism initiatives into staff meetings and mandating anti-ageism training could support the continuation of practice for older nurses while fostering a more age-diverse nursing workforce.
We found evidence on the presence of ageism in older nurses' workplace and the detrimental effects of ageism on older nurses' well-being and continuation of practice. Importantly, we identified a lack of organisational initiatives to address ageism and support older nurses. These findings should encourage healthcare organisations to address ageism in older nurses' practice settings and prompt policymakers to develop age-inclusive policies that support older nurses' continuation of practice.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-analysis checklists were used to report the screening process.
The PROSPERO registration number for the review was CRD42022320214 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320214).
No Patient or Public Contribution.
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