Research and Knowledge Translation Priorities for the Prehospital Care of Older Adults: A Modified Delphi Study

Older adults account for a substantial proportion of emergency medical services (EMS) encounters. Despite increasing recognition of older adults as a distinct population within EMS, a minimal amount of work has been conducted to describe knowledge and practice gaps or to establish priorities for future research or translation. The objective of this study was to identify research and knowledge translation priorities with the greatest perceived potential to improve prehospital care for older adults.

We conducted a modified Delphi study involving a multidisciplinary stakeholder panel including EMS clinicians, medical directors, educators, researchers, quality improvement leaders, geriatricians, emergency physicians, long-term care providers, and health system leaders. Four rounds of asynchronous electronic surveys were conducted between September 2025 and May 2026. Participants generated candidate priorities, classified them as research gaps, knowledge translation gaps, or both, and subsequently ranked priorities separately within the research and knowledge translation domains. High-priority, high-consensus topics were defined as those with a mean rank score ≤5 and inclusion within the top 10 priorities of more than 50% of participants.

Twenty-eight of 30 invited stakeholders completed Round 1. Participants generated 145 candidate priorities, which were consolidated into 30 themes. Substantial overlap was observed between research and knowledge translation priorities, with many topics classified as both. Seventeen priorities advanced to final ranking. Five high-priority, high-consensus topics were identified in both the research and knowledge translation domains, with four priorities shared between the lists. Shared priorities reflected several assessment-related themes, including evaluation following perceived low-acuity falls, fall prevention, clinician training, and assessment tools and resources. The primary difference between the lists was the inclusion of alternatives to transport and care-in-place models among research priorities and trauma triage of older adults among knowledge translation priorities. All final-round participants agreed with the prioritized lists.

Research and knowledge translation priorities for the prehospital care of older adults demonstrated substantial overlap. Assessment-related topics, particularly the evaluation of older adults presenting after perceived low-acuity falls, emerged as consistent priorities across domains. These findings provide a stakeholder-informed roadmap to guide future research, education, quality improvement, and implementation efforts aimed at improving outcomes for older adults receiving EMS care.