Abstract
Urgent Community Assessment: A realist review of what works, for whom, and in what circumstances for older adults after a fall.
P Garraway1; L Woods1; B Raut1; R Dewar-Haggart2; S Lunuwila1; S McKelvie1
1University of Southampton 2University of Oxford
Introduction: Falls have a considerable effect on the physical and mental health of older adults. Urgent Community Response (UCR) services are increasing offered as a Community Alternative to aCute Hospitalisation (CAtCH) for falls management. These services often provide a home based assessments following an fall but there is limited understanding of how and for whom these services should be utilised.
Aims: This study used a realist approach to review the literature and generate theories as to how, why and in what context, urgent community assessment could work for older people who have fallen at home.
Methods: We searched 3 databases (Medline, Embase and CINAHL) for literature that discussed older people who were assessed in community settings by UCR, following a non-traumatic fall. Our search strategy used synonyms for Aged, Falls and UCR service types. Papers were selected based on relevance when forming theories.
Results: 472 papers were found and 27 discussed UCR. Full text screening resulted in 14 articles for inclusion, which were assessed for relevance and quality. We found appropriate referral could be improved with training, effective triage and adapting to patient needs. Additional referral pathways may enable service access, whilst UCR provision offers the choice of home-based treatment. Home-based care is well established, which may support acceptability of UCR. However, availability was sometimes limited in rural areas. Finally, although UCR decreased hospital costs through admission avoidance, it could add informal costs to carers.
Conclusions: Falls have a large impact on patients, families and carers. UCR may allow for home-based care and be helpful at directing onward care, even within hospital. Team working in UCR services may support reducing hospitalisations and falls prevention. Further research is needed to improve UCR triage processes, and health systems should consider how UCR services can be integrated for falls management for older people.