Title: Impact of interventions to improve recovery of older adults following planned hospital admission on quality of life following discharge: linked evidence synthesis
Funder: Department of Health and Social Care

Abstract: Older adults are at risk of difficulties such as falls, confusion and infections when they are admitted to hospital. To reduce the risk of these difficulties occurring, it is important they don’t spend any longer in hospital than they need to. _x000D_ _x000D_ In a previous study, we looked at evidence about approaches to improve recovery and achieve earlier discharge for older adults. We were interested in strategies that combined several different elements to reduce hospital stay and improve recovery. This research showed that the different strategies, such as improving fitness before coming to hospital, using different pain relief and getting out of bed earlier after surgery, were either better than or no worse than normal care. However, patient satisfaction, mental health and quality of life were rarely considered and recovery after hospital discharge was not often measured. _x000D_ _x000D_ This means we don’t know much about what older adults, or their carers, think about the ways hospitals try to improve their recovery or whether being discharged sooner affects their wellbeing and quality of life after they leave hospital. This information is needed to make sure older adults receive appropriate care both in hospital and when they go home, and ensure that efforts to achieve early discharge from hospital do not place additional burden on patients and their carers, or on other community services._x000D_ _x000D_ We aim to find out more about the experiences of strategies that are intended to reduce the length of time older adults spend in hospital after receiving planned surgery, and about the effect these strategies have on patient recovery and service use after leaving hospital. This information can inform the way hospitals, carers and community services plan the recovery of older adults undergoing scheduled surgery. _x000D_ _x000D_ To do this, we will carry out three pieces of work:_x000D_ _x000D_ 1) A review of studies which measure the impact of care pathways aiming to reduce the length of hospital stay for older adults after planned treatment, focusing on bringing together information on patient satisfaction, quality of life and post-discharge health and social care service use._x000D_ 2) A review which combines findings from studies which focus on the views of older adults, their family or carers and health/social care staff of the strategies intended to reduce the length of time they spend in hospital._x000D_ 3) An analysis which combines the results from the two reviews to understand how the delivery or content of the strategies to manage the recovery of older adults after planned treatment may impact on their wellbeing, satisfaction and use of services before and after hospital discharge._x000D_ _x000D_ For our last review, we worked with a group of older adults with experience of planned hospital admissions. It was their enthusiasm for addressing this important gap in the knowledge that led us to develop this funding bid. They have been involved in the preparation of the application, including commenting on this summary, and will continue to shape the research as we progress. _x000D_ _x000D_ In addition to journal publications, we will share the findings from this project using a variety of accessible formats, including blog posts, briefing papers and podcasts, targeted to specific audiences. Our established relationships with our clinical and patient experts will help get the research findings to the people who stand to benefit, as well as those who design, plan and deliver services.

Lay abstract: 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. _x000D_ _x000D_ 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. _x000D_ _x000D_ 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._x000D_ _x000D_ Our research questions are:_x000D_ _x000D_ 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?_x000D_ 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?_x000D_ 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?_x000D_ _x000D_ Methods: We will conduct two individual reviews and an overarching synthesis:_x000D_ _x000D_ 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._x000D_ _x000D_ 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._x000D_ _x000D_ 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._x000D_ _x000D_ 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. _x000D_ _x000D_ 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.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE