Strategies to improve care for older adults who present to the emergency department: a systematic review.

BACKGROUND: The aim of this systematic review was to examine the relationship between strategies to improve care delivery for older adults in ED and evaluation measures of patient outcomes, patient experience, staff experience, and system performance. METHODS: A systematic review of English language studies published since inception to December 2022, available from CINAHL, Embase, Medline, and Scopus was conducted. Studies were reviewed by pairs of independent reviewers and included if they met the following criteria: participant mean age of ≥ 65 years; ED setting or directly influenced provision of care in the ED; reported on improvement interventions and strategies; reported patient outcomes, patient experience, staff experience, or system performance. The methodological quality of the studies was assessed by pairs of independent reviewers using The Joanna Briggs Institute critical appraisal tools. Data were synthesised using a hermeneutic approach. RESULTS: Seventy-six studies were included in the review, incorporating strategies for comprehensive assessment and multi-faceted care (n = 32), targeted care such as management of falls risk, functional decline, or pain management (n = 27), medication safety (n = 5), and trauma care (n = 12). We found a misalignment between comprehensive care delivered in ED for older adults and ED performance measures oriented to rapid assessment and referral. Eight (10.4%) studies reported patient experience and five (6.5%) reported staff experience. CONCLUSION: It is crucial that future strategies to improve care delivery in ED align the needs of older adults with the purpose of the ED system to ensure sustainable improvement effort and critical functioning of the ED as an interdependent component of the health system. Staff and patient input at the design stage may advance prioritisation of higher-impact interventions aligned with the pace of change and illuminate experience measures. More consistent reporting of interventions would inform important contextual factors and allow for replication.

Importance of role models and mentors for improving care for late-deafened adults who become cochlear implant recipients.

OBJECTIVE: There were two objectives of this current study. (1) To understand the impacts of hearing loss for late-deafened adults and the experiences of support received both from hearing healthcare providers and peers. (2) To understand the types of support needed during and after a cochlear implant. DESIGN: The study used mixed methods. A survey was posted to three cochlear implant social media groups and participants could self-select to participate in a semi-structured interview by leaving their email address.Study sample: Forty-four late-deafened adults who had also received at least one cochlear implant answered the survey and 16 people were interviewed. RESULTS: A key finding was that most late-deafened adults did not have access to support through the progression of deafness. They often felt alone, making it difficult to maintain their sense of self while reconciling with the hearing changes forced on them. When participants had positive role models who had experienced hearing loss, or mentors who had undergone cochlear implantation, it assisted them in navigating their changing hearing status. Thus, improved connection to peers sustained self-esteem and improved coping strategies. CONCLUSIONS: The findings suggest hearing healthcare providers need to introduce a mentoring and support structure for connected care.

Identity change of late-deafened adults after receiving cochlear implants.

PURPOSE: The aim of this research was to understand how adults reconceptualise their identity when experiencing hearing loss as an adult, and how their identity might change with a cochlear implant. MATERIALS AND METHODS: Using an online survey administered through cochlear implant social media groups, with follow-up semi-structured interviews, participants answered questions about their hearing loss and cochlear implant experiences. Forty-four people answered the survey and 16 participated in an in-depth interview. All were older than 18 years, once had heard, became deafened in adulthood and had at least one cochlear implant. RESULTS: The decision to have a cochlear implant often meant acknowledging they were no longer a hearing person. After having an implant four themes emerged. (1) Some participants maintained a hearing identity through hearing loss and after cochlear implantation, while others returned to their hearing identity. (2) Others acknowledged a confused identity, neither deaf nor hearing. In unexpected findings, (3) during the progression of hearing loss, some participants had identified as hearing but could not hear, however after implantation, they became deaf people who could hear. (4) Furthermore, after implantation, some participants identified as disabled when they had not done so when less able to hear. CONCLUSION: Given the prevalence of hearing loss in later life, it is important to understand the way these adults understand their identity through the progression of hearing loss and after becoming cochlear implant recipients. The belief people have of themselves impacts healthcare choices and affects their commitment to ongoing rehabilitation.

Rehabilitation may often be overlooked by hearing healthcare providers, but it is a critical component of hearing healthcareHearing healthcare providers need rehabilitation strategies which recognise psychosocial issues impacting late-deafened adults and include counselling to help individuals cope with stigma and identity issues during different stages of hearing loss and cochlear implantationHearing rehabilitation may overlook concepts of identity, although identity is a critical part of living with hearing lossThe way a person identifies is likely to impact on their approach to rehabilitation.