The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews

• Published in: BMC geriatrics Vol. 24; no. 1; p. 484
• Main Authors: Balqis-Ali, Nur Zahirah, Jawahir, Suhana, Chan, Yee Mang, Lim, Amanda Wei-Yin, Azlan, Ummi Wahidah, Shaffie, Sal Sabila Mohd, Fun, Weng Hong, Lee, Shaun Wen Huey
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.06.2024; BioMed Central; BMC
• Subjects: Aged; Aged, 80 and over; Aging; Caregivers; Chronic illnesses; Citation management software; Demographics; Disease; Economic aspects; Emergency medical care; Health aspects; Health care; Health services utilization; Healthcare utilisation; Hospitals; Humans; Intervention; Length of stay; Long term health care; Long-term care; Long-Term Care - methods; Long-Term Care - trends; Long-term care of the sick; Medical care; Meta-analysis; Older people; Older persons; Patient Acceptance of Health Care; Population; Population aging; Primary care; Reviews; Scoping review; Systematic review; Technology assessment; Utilization; Malaysia; Scoping review; Older persons; Long-term care; Healthcare utilisation
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-024-05097-9

As the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons. A scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE. Thirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality. The findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.