Skip to main content


BEETLE (BEttEr ouTcomes for oLder pEople) is investigating multicomponent interventions to support older people after planned surgery, using mixed-method systematic review

The number of older adults who are admitted to hospital for planned treatment within the UK is rising. This population have different needs to younger adults which may significantly prolong their hospital stay and increase their risk of hospital acquired harms such as falls and urinary infections. To reduce these risks, it is imperative their length of hospital stay (LOS) is optimised.

Multi-modal strategies to optimise older adults’ LOS, such as Enhanced Recovery Protocols and Prehabilitation programmes, are effective at reducing LOS, without increasing complications or readmissions, across a range of surgical procedures. However, effects on patient reported outcomes (PROMs) or experiences (PREMs), within hospital and beyond 30 days from surgery are largely unknown. Older adults may require additional support following a surgical procedure, so it is vital to understand the impact of earlier discharge on their quality of life, wellbeing and ongoing service use.

The project builds on work conducted by the Exeter HS&DR Evidence Synthesis Centre, which comprehensively evaluated the effectiveness of hospital-led interventions that aim to improve the recovery of older adults undergoing planned surgical procedures requiring an overnight stay in hospital, to the extent that they are able to be safely discharged more quickly.  The current evidence synthesis  focuses on the longer-term outcomes of these approaches and will also investigate how patients, their family and carers and hospital staff view the different types of intervention intended to help discharge older adults faster.

Overall aims and objectives

  • To conduct a mixed-methods evidence synthesis to establish how multi-modal interventions to enhance recovery after planned surgery impact on mid to long term outcomes for older adults, and understand patient, carer and healthcare professionals’ experiences of such interventions.
  • To understand factors associated with better or worse outcomes.

We will conduct two individual reviews and an overarching synthesis:

  1. A systematic review of the quantitative evidence evaluating the effectiveness of multi-modal interventions aiming to reduce LOS and/or enhance the recovery of older adults admitted for planned treatment on PROMs, PREMs and health and social care service utilisation following discharge from hospital.
  2. A systematic review of qualitative evidence exploring the experiences and views of older adults admitted for planned treatment, their family or carers and health/social care staff, of multi-modal interventions intending to reduce the LOS and/or enhance their recovery.
  3. An overarching synthesis to integrate the results from the two systematic reviews to develop a logic model identifying aspects of care which are associated with positive or negative outcomes.

PROSPERO registration number: CRD42021230620
Source of funding
This report was commissioned by the NIHR HS&DR programme: NIHR130576.

The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. Any errors are the responsibility of the authors.