Barriers and facilitators to implementing digital psychosocial interventions for older adults presenting to emergency departments: a scoping review

Globally, we are experiencing an ageing population. In high-income countries, many individuals aged over 60 years live with at least one chronic condition. Among older people, certain psychosocial factors are associated with increased risk of experiencing an emergency department (ED) presentation. These presentations may have negative physical and psychological outcomes for individuals and place additional burdens on health resources. The implementation of digital psychosocial interventions could help create age-friendly EDs and improve holistic healthcare provision, reduce re-presentations and better address the challenges faced by older adults. This scoping review aimed to identify and synthesise the barriers and facilitators to implementing digital psychosocial interventions designed for older adults to assess or manage non-primary psychosocial complaints in ED. Four databases and Google Scholar were searched for experimental, observational and qualitative peer-reviewed studies or grey literature published in English. Papers were considered for inclusion if they described the perspectives of key stakeholders (older adults, family, or healthcare providers) on the implementation of digital psychosocial interventions designed for older adults in emergency settings. Study selection and data extraction were performed in duplicate, with the Theoretical Domains Framework used to synthesise barriers and facilitators. Eight papers from four countries met the eligibility criteria. They employed qualitative and/or quantitative methods and reported on digital interventions addressing various psychosocial needs. Older adults identified the highest number of barriers and facilitators, followed by healthcare providers, with families and caregivers reporting the fewest. The barriers recognised by older adults included a lack of technological skills and a fear or aversion to technology, while facilitators were improved privacy and designing digital psychosocial interventions to enhance user experience. Healthcare professionals faced barriers due to ED’s demanding environment and heavy workloads. However, supportive leadership was noted as a facilitator for implementation. Families and caregivers were the least involved stakeholders, resulting in very few barriers or facilitators being identified in this group. The barriers and facilitators identified in this review highlight that there is promising evidence to support the implementation of digital psychosocial interventions that are co-designed with older adults, families and clinicians to improve care and reduce workloads.