EMERGENCY DEPARTMENT STAFF PRIORITIES FOR IMPROVING PALLIATIVE CARE PROVISION FOR OLDER ADULTS: A SYSTEMATIC REVIEW

Abstract

Background: Older adults with life-limiting conditions often present to emergency departments (EDs) in acute distress, yet these settings are not traditionally designed to deliver comprehensive palliative care. Integrating palliative principles into ED workflows can improve quality of life, align care with patient preferences, and reduce unnecessary interventions.

Objective: To synthesize empirical evidence on the priorities, barriers, and facilitators for improving palliative care provision for older adults in ED settings.

Methods: This systematic review followed PRISMA 2020 guidelines. Databases including PubMed, Scopus, Web of Science, and Embase were searched for peer-reviewed studies published between 2010 and 2025. Eligible studies involved older adult populations, explored palliative care within EDs, and reported quantitative or qualitative outcomes related to barriers, facilitators, and service priorities. Data extraction and quality appraisal were conducted independently by two reviewers.

Results: Twenty-one studies met inclusion criteria, encompassing qualitative, cross-sectional, cohort, and randomized designs. Key findings included: (1) persistent late initiation of palliative care; (2) significant gaps in clinician training and confidence; (3) systemic barriers such as time constraints, lack of privacy, and fragmented care pathways; and (4) facilitators including structured screening tools, multidisciplinary teams, and improved ED–community linkages. Alignment was observed between patient/family and provider priorities, but implementation was hindered by structural and cultural barriers.

Conclusions: ED-based palliative care for older adults requires systemic integration, targeted education, and institutional support. Screening tools and multidisciplinary pathways can enhance early identification and care coordination. Addressing inequities in access and embedding palliative approaches across the continuum of care are essential for sustainable improvement.