Addressing organizational risk factors and interventions during transitions of care for older patients: a systematic umbrella review

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BACKGROUND: The global aging population presents significant challenges for healthcare systems, with projections indicating that by 2050, individuals aged 65 and above will total 1.6 billion. Older adults, often experience chronic conditions and face frequent transitions in care, which can result in fragmented care and increased risks. Communication issues, poor discharge planning, and lack of standardized procedures contribute to patient safety concerns during these transitions. Addressing such risks through effective organizational interventions is crucial for improving patient outcomes. Existing research often isolates organizational risks and interventions, overlooking their combined impact on patient safety across care settings. Therefore, this systematic umbrella review aims to identify and synthesize organizational risk factors and interventions related to patient safety outcomes in transitions of care, including a hospital admission or an emergency department visit, for older adults aged 65 and above. METHODS: This systematic umbrella review reported following the PRISMA 2020 statement criteria. A literature search (in Medline, Embase, CINAHL and Scopus) was performed from inception up to November 18, 2025, in collaboration with a medical information specialist. Two screening strategies (Excel and ASReview) were utilized for study selection and data extraction was guided by a predefined data extraction tool. Quality of studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Data were analysed thematically and narratively synthesized. RESULTS: A total of 29,587 records were identified, with 18 reviews meeting eligibility criteria for inclusion. Three reviews examined organizational risk factors, highlighting issues in communication, discharge documentation, and coordination. Fifteen reviews focused on interventions, most often discharge planning and medication management, with two reviews also examining organizational risk factors. Other frequently mentioned interventions included patient education, interdisciplinary collaboration, and home-based interventions. Primary outcome categories included readmissions, medication-related outcomes, and health service use. CONCLUSION: This systematic umbrella review identifies key organizational risk factors and interventions influencing patient safety outcomes during care transitions for older adults. Interventions are often multifaceted and highlight the importance of context-specific and adaptable strategies to effectively enhance patient safety outcomes. PROTOCOL REGISTRATION: CRD420251034128.

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