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Clinical Decision Support Tools in Older Adults When Considering Disposition Decisions: A Scoping Review
Niamh Walsh1, Fiona He2, Frank Keane1
1Paramedic Studies, School of Medicine, University of Limerick, Limerick, Ireland.
Journal of the American Medical Directors Association
|April 29, 2026
Summary
Clinical decision support (CDS) tools help identify older adults for alternative care pathways. However, most tools lack robust validation, highlighting a need for better development and testing in disposition decisions.
Area of Science:
- Geriatric medicine
- Health informatics
- Healthcare systems research
Background:
- Alternative care models are gaining traction for older adults.
- Clinical decision support (CDS) tools aim to facilitate safe transitions to these pathways.
- The characteristics and validation status of existing CDS tools are not well-understood.
Purpose of the Study:
- To identify and map published CDS tools for older adults.
- To analyze the scope and validation of these tools.
- To pinpoint gaps in the current literature regarding CDS for alternative care pathways.
Main Methods:
- A comprehensive scoping review of peer-reviewed and gray literature.
- Inclusion of CDS tools developed or validated for older adults in healthcare settings.
- Data extraction on tool characteristics, implementation, and outcomes.
Main Results:
- Seven CDS tools were identified, primarily for directing patients to out-of-hospital settings.
- Tools varied significantly in structure, parameters, and outcome measures.
- Limited formal validation and diagnostic performance data were reported, despite some suggesting safe outcomes and reduced acute care use.
Conclusions:
- Existing CDS tools can aid disposition decision-making for older adults.
- The evidence base is heterogeneous, with a lack of robust validation for older-adult-specific tools.
- There is a clear need for developing and validating CDS tools for disposition decisions in this population.
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