Background: Older age and higher acuity are associated with prolonged hospital stays and hospital readmissions.
Early discharge planning may reduce lengths of hospital stay and hospital readmissions; however, its effectiveness
with acutely admitted older adults is unclear.
Methods: In this systematic review, we compared the effectiveness of early discharge planning to usual care in
reducing index length of hospital stay, hospital readmissions, readmission length of hospital stay, and mortality; and
increasing satisfaction with discharge planning and quality of life for older adults admitted to hospital with an
acute illness or injury.
We searched the Cochrane Library, DARE, HTA, NHSEED, ACP, MEDLINE, EMBASE, CINAHL, Proquest Dissertations
and Theses, PubMed, Web of Science, SciSearch, PEDro, Sigma Theta Tau International’s registry of nursing research,
Joanna Briggs Institute, CRISP, OT Seeker, and several internet search engines. Hand-searching was conducted in
four gerontological journals and references of all included studies and previous systematic reviews. Two reviewers
independently extracted data and assessed risk of bias. Data were pooled using a random-effects meta-analysis.
Where meta-analysis was not possible, narrative analysis was performed.
Results: Nine trials with a total of 1736 participants were included. Compared to usual care, early discharge
planning was associated with fewer hospital readmissions within one to twelve months of index hospital discharge
[risk ratio (RR) = 0.78, 95% CI = 0.69 − 0.90]; and lower readmission lengths of hospital stay within three to
twelve months of index hospital discharge [weighted mean difference (WMD) = −2.47, 95% confidence intervals
(CI) = −4.13 − −0.81)]. No differences were found in index length of hospital stay, mortality or satisfaction with
discharge planning. Narrative analysis of four studies indicated that early discharge planning was associated with
greater overall quality of life and the general health domain of quality of life two weeks after index hospital
discharge.
Conclusions: Early discharge planning with acutely admitted older adults improves system level outcomes after
index hospital discharge. Service providers can use these findings to design and implement early discharge
planning for older adults admitted to hospital with an acute illness or injury