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

Background: The number of older adults who are admitted to hospital for planned treatment within the UK is rising. This population have different needs to younger adults which may significantly prolong their hospital stay and increase their risk of hospital acquired harms such as falls and urinary infections. To reduce these risks, it is imperative their length of hospital stay (LOS) is optimised.

Multi component strategies to optimise older adults’ LOS, such as Enhanced Recovery Protocols and Pre-habilitation programmes, are effective at reducing LOS, without increasing complications or readmissions, across a range of surgical procedures. However, effects on patient reported outcomes (PROMs) or experiences (PREMs), within hospital and beyond 30 days from surgery are largely unknown.

Older adults may require additional support following a surgical procedure, so it is vital to understand the impact of earlier discharge on their quality of life, wellbeing and ongoing service use.

Aims and objectives: To conduct a mixed-methods evidence synthesis to establish how multi component interventions to enhance recovery after planned surgery impact on mid to long term outcomes for older adults, and understand patient, carer and healthcare professionals’ experiences of such interventions, and to understand factors associated with better or worse outcomes.

Our research questions are:

1. What is the impact of multi component interventions to enhance recovery and/or reduce LOS for older adults admitted for planned procedures on patient reported outcome measures and service utilisation?

2. What are the experiences of patients receiving multi component interventions to enhance recovery and/or reduce LOS, their family and carers and staff involved with delivering care within these interventions?

3. Which aspects of multi component interventions to enhance recovery and/or reduce LOS are associated with better outcomes for older adults admitted to hospital for planned procedures? Methods: We will conduct two individual reviews and an overarching synthesis:

1. A systematic review of the quantitative evidence evaluating the effectiveness of multi component interventions aiming to reduce LOS and/or enhance the recovery of older adults admitted for planned treatment on PROMs, PREMs and health and social care service utilisation following discharge from hospital.

2. A systematic review of qualitative evidence exploring the experiences and views of older adults admitted for planned treatment, their family or carers and health/social care staff, of multi component interventions intending to reduce the LOS and/or enhance their recovery.

3. An overarching synthesis to integrate the results from the two systematic reviews to develop a logic model identifying aspects of care which are associated with positive or negative outcomes.

Impact and Dissemination: In addition to publications in peer-reviewed, open access academic journals, we will produce accessible dissemination materials including briefing papers, podcasts, plain language summaries and blog posts. These will be shared via pathways developed with our clinical and patient stakeholders.

In the short term, our findings should help educate patients, their carers and hospital clinicians about the needs of older adults following hospital discharge. In the longer term, findings should inform the commissioning, design and delivery of care pathways for older adults admitted to hospital for planned procedures.