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Knight T, Kamwa V, Atkin C, Green C, Ragunathan J, Lasserson D, Sapey E. Acute care models for older people living with frailty: a systematic review and taxonomy. BMC Geriatr 2023; 23:809. [PMID: 38053044 PMCID: PMC10699071 DOI: 10.1186/s12877-023-04373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 10/03/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear. METHODS A systematic review was conducted to derive a taxonomy of acute care models for older people with acute medical illness and describe the outcomes used to assess their effectiveness. Care models providing time-limited episodes of care (up to 14 days) within 48 h of presentation to patients over the age of 65 with acute medical illness were included. Care models based in hospital and community settings were eligible. Searches were undertaken in Medline, Embase, CINAHL and Cochrane databases. Interventions were described and classified in detail using a modified version of the TIDIeR checklist for complex interventions. Outcomes were described and classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Risk of bias was assessed using RoB2 and ROBINS-I. RESULTS The inclusion criteria were met by 103 articles. Four classes of acute care model were identified, acute-bed based care, hospital at home, emergency department in-reach and care home models. The field is dominated by small single centre randomised and non-randomised studies. Most studies were judged to be at risk of bias. A range of outcome measures were reported with little consistency between studies. Evidence of effectiveness was limited. CONCLUSION Acute care models for older people living with frailty are heterogenous. The clinical effectiveness of these models cannot be conclusively established from the available evidence. TRIAL REGISTRATION PROSPERO registration (CRD42021279131).
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Affiliation(s)
- Thomas Knight
- Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Vicky Kamwa
- Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Catherine Atkin
- Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Catherine Green
- Department of Geriatric Medicine, Whiston Hospital, Mersey and West Lancashire Teaching Hospital NHS Trust, Prescot, L35 5DR, UK
| | - Janahan Ragunathan
- Department of Geriatric Medicine, Royal Bolton NHS Foundation Trust, Bolton, BL4 0JR, UK
| | - Daniel Lasserson
- Warwick Medical School, Professor of Acute and Ambulatory Care, University of Warwick, Coventry, CV4 7AL, UK
| | - Elizabeth Sapey
- Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
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Karamercan MA, Dündar DZ, Slagman A, Ergin M, Janssens KAC, Fabbri A, Bjornsen LP, Somodi S, Adam VN, Polyzogopoulou E, Demir HA, Laribi S. Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study. Eur J Emerg Med 2023; 30:117-124. [PMID: 36719188 DOI: 10.1097/mej.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND IMPORTANCE Patients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries. OBJECTIVE The primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs. DESIGN SETTING AND PARTICIPANTS An observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included. OUTCOME MEASURES Data were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years). MAIN RESULTS A total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay. CONCLUSION The characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.
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Affiliation(s)
- Mehmet A Karamercan
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Defne Z Dündar
- Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara
| | - Ana Slagman
- Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charite Universitatmedizin, Berlin, Germany
| | - Mehmet Ergin
- Department of Emergency Medicine, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | | | - Andrea Fabbri
- Dipartimento Emergenza, Azienda USL della Romagna, Forli, Italy
| | - Lars P Bjornsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sándor Somodi
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Visnja N Adam
- Department of Anesthesiology, Resuscitation and Intensive Care, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Effie Polyzogopoulou
- Emergency Medicine Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Hüseyin A Demir
- Department of Emergency Medicine, Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
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Referral pathway of patients aged 75 years and older after a telephone triage by the French emergency medical communication center (SAMU). Arch Gerontol Geriatr 2019; 84:103893. [PMID: 31202586 DOI: 10.1016/j.archger.2019.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 04/19/2019] [Accepted: 05/27/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To map the referral pathways of elderly people after telephone calls to Emergency Medical Communication Centers (ECC) in France. DESIGN Retrospective observational study. SETTING ECC and Emergency Departments (ED) of the Rhone region in France in 2013. PARTICIPANTS Patients aged 75 years and older who called or had calls made to the ECC on 7 non-consecutive days (n = 712). MEASUREMENTS All calls made by/for patients aged 75 and over were analyzed. Data were collected regarding geriatric assessment and patient discharge destination after admission to an ED. RESULTS All 4168 calls received over the 7 days were analyzed. Of these, 692 involved the care of elderly people and were included. The median call duration was 2min59 [1min57; 4min13]. Following the call, 35% of the patients remained at home, 62% were referred to ED and 3% were directly hospitalized in intensive care units. Of the patients admitted to ED, 73% had a stable clinical condition and the main reason for admission was a fall (28%). Following ED care, 56% of patients were hospitalized and 44% returned directly home. CONCLUSION Over half the elderly patients included in this study were referred to an ED after a call to ECC. For half of them, their clinical condition was considered stable and they were discharged after the ED visit. A more appropriate assessment of clinical conditions among geriatric patients could help to improve patient triage during ECC calls, and therefore reduce ED referrals.
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Lui CT, Ching WM, Tsui KL, Chu HC, Tsui ATS, Au TS, Wong TW, Fan KL, Leung LP. Feasibility of predictive model by clinical and laboratory parameters for risk stratification of geriatric abdominal pain. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918802070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Assessment of geriatric patients presented with abdominal pain had been challenge for emergency physicians with the ageing population. A rapid, reproducible risk stratification model for the assessment of the need for admission for geriatric abdominal pain would be required to identify low-risk patients to be managed as out-patient basis. Objective: Assess the feasibility of risk stratification model to predict the need of hospital admission based on readily available bedside parameters in emergency departments. Methods: This is a multicenter retrospective cohort study in four emergency departments. Patients aged at least 65 who presented with chief complaint of abdominal pain within the previous 7 days of attendance as the chief complaint were included. Chart review was performed for the included patients. The primary outcome was defined as a composite of mortality, abdominal surgery or endoscopic treatment, and other inpatient treatments for abdominal diseases within 14 days, surrogating the need of hospital admission. Logistic regression was modeled to identify independent predictors. The diagnostic accuracy of the risk model was evaluated with the receiver operating characteristic curve and compared with the clinical gestalt of decision for hospital admission by the attending physician. Results: In total, 553 patients were included. Symptoms of upper gastrointestinal bleeding, non-ambulatory presenting status, pain duration, focal abdominal tenderness, hyperglycemia, leukocytosis, and elevated creatinine were independent predictors of the outcome. The area under the receiver operating characteristic curve of the predicted probabilities of the logistic model was 0.741. In keeping for a low-risk criterion to achieve more than 90% sensitivity, the predictive model would only achieve 18.2% specificity which was inferior to clinical gestalt for hospital admission (sensitivity 99.3%, specificity 44.3%). Conclusion: Risk stratification model by clinical assessment and laboratory markers alone were inadequate and inferior to clinical gestalt for identification of the group of patients requiring inpatient treatment.
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Affiliation(s)
- Chun Tat Lui
- Accident and Emergency Department, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Wei Ming Ching
- Accident and Emergency Department, Pok Oi Hospital, Yuen Long, Hong Kong
| | - Kwok Leung Tsui
- Accident and Emergency Department, Pok Oi Hospital, Yuen Long, Hong Kong
| | - Ho Cheung Chu
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Alex To Shing Tsui
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Tak Shun Au
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Tai Wai Wong
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Kit Ling Fan
- Accident and Emergency Department, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ling Pong Leung
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Prediction of Emergency Department Re-Visits in Older Patients by the Identification of Senior at Risk (ISAR) Screening. Geriatrics (Basel) 2018; 3:geriatrics3030033. [PMID: 31011071 PMCID: PMC6319249 DOI: 10.3390/geriatrics3030033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
The “Identification of Seniors at Risk” (ISAR) screening is a tool to identify seniors at risk of adverse outcomes. We investigated whether seniors with a positive ISAR screening have an increased risk of Emergency Department (ED) re-visits and health-service costs. In a pilot project, we enrolled 96 ED patients (≥70 years) who received an ISAR screening in the ED. We compared the rate of ED re-visits and in-hospital costs between ISAR positive (≥2 pts) and ISAR negative (<2 pts) patients. In some patients, a geriatrician performed a single Geriatric Consultation (GC) during the ED stay to assess older patients’ needs.32% of the study population had an unplanned ED re-visit (31 of 96). Fifty patients were ISAR positive (52%) and showed an increased risk of ED re-visits compared with ISAR negative patients (dds ratio (OR) 6.8, 95% confidence interval (CI) 2.2–21.0, p = 0.001). The positive ISAR screening tool fairly predicted ED re-visits in seniors (area under the curve (AUC) 0.711). A single GC during the ED stay did not reduce the risk of unplanned ED re-visits in ISAR positive patients (p = 0.80) ISAR positive patients with GC did not have higher in-hospital costs than ISAR negative patients without GC. Based on these findings, we aim to establish a comprehensive outpatient geriatric assessment program to identify relevant risk factors for ED re-visits and to recommend preventive strategies in ISAR positive ED seniors.
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Mobility assessments of geriatric emergency department patients: A systematic review. CAN J EMERG MED 2017; 20:353-361. [DOI: 10.1017/cem.2017.46] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACTObjectivesWe wished to determine the impact of emergency department (ED) mobility assessments for older patients on hospitalization, return visits, future falls, and frailty.MethodsWe searched MEDLINE, Embase, CINAHL, Cochrane Library, PEDro, and OTseeker (September 2016). Two independent reviewers identified studies of patients ≥65 years with ED physical mobility assessments and outcomes of hospitalization, return to ED, falls, and frailty. Language was not restricted. Only clinical trials and observational studies were included.ResultsWe identified 1,365 unique citations. Nine studies (six cohort and three cross-sectional) met full inclusion criteria. Patients (n=2,513) with mean age 75-85 years, admitted to hospital and discharged, underwent these ED evaluations: Timed Up and Go (TUG), Get Up and Go, tandem walk, and a gait assessment. Study quality was moderate to poor. Tandem walk did not predict falls at 90 days. TUG was not associated with return to the ED/hospitalization at 90 days. Get Up and Go was associated with hospital admission but not return to ED visits at 1 or 3 months. Due to clinical heterogeneity in study populations and outcomes, a meta-analysis was not undertaken.ConclusionsDespite multiple guidelines recommending a mobility assessment prior to ED discharge for older patients, we found that such assessments were neither associated with nor predictive of adverse outcomes. Robust research is required to guide clinicians on the utility of physical mobility assessments in older ED patients.
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Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management. Eur Radiol 2016; 27:868-877. [PMID: 27271919 DOI: 10.1007/s00330-016-4425-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 12/14/2022]
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Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain. ACTA ACUST UNITED AC 2016; 40:2877-82. [PMID: 25862547 DOI: 10.1007/s00261-015-0419-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the study was to document the clinical impact of CT in elderly patients presenting to the emergency department (ED) with abdominal pain. METHODS This retrospective IRB-approved study from 2006 to 2013 evaluated 464 patients ≥80 years (mean 89 years, range 80-100: M150, W314), who presented to the ED with acute abdominal symptoms and underwent CT. CTs were divided into those negative and positive for actionable findings, defined as potentially requiring a change in surgical or medical management. Physician diagnosis, treatment plan, and disposition before and after CT were reviewed in the electronic medical record to assess CT influence on management and disposition. CT diagnosis was confirmed with final clinical diagnosis, surgical intervention, pathology, and follow-up. Descriptive statistics were used. RESULTS CTs were positive in 55%. The most common diagnoses were SBO (18%), diverticulitis (9%), non-ischemic vascular-related emergency (6%), bowel ischemia (4%), appendicitis (3%), and colonic obstruction (2%). These diagnoses were clinically unsuspected prior to CT in 43% (p < 0.05), with significant difficultly in diagnosing SBO (p < 0.05), diverticulitis (p < 0.01), and colonic obstruction (p < 0.01). Positive CT results influenced treatment plans in 65%, surgical in 48%, and medical in 52%. Disposition from the ED was significantly affected by CT (p < 0.001), 65% of admissions with positive CT (p < 0.001) and 63% of discharges with negative CT (p < 0.001). CONCLUSION Utilization of abdominopelvic CT in geriatric patients presenting to the ED with acute abdominal symptoms strongly influences clinical management and significantly affects disposition. As the US population ages, the clinical impact of emergent CT in the elderly will intensify.
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Goto T, Yoshida K, Tsugawa Y, Camargo CA, Hasegawa K. Infectious Disease-Related Emergency Department Visits of Elderly Adults in the United States, 2011-2012. J Am Geriatr Soc 2015; 64:31-6. [PMID: 26696501 DOI: 10.1111/jgs.13836] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the frequency of infectious disease (ID)-related emergency department (ED) visits of elderly adults in the United States. DESIGN Cross-sectional analysis. SETTING Nationwide emergency department sample in 2011-12. PARTICIPANTS Individuals in the ED aged 65 and older with a primary diagnosis of an ID. MEASUREMENTS ID-related ED visits, hospitalizations, hospital-based mortality. RESULTS During 2012, a weighted estimate of 3,123,909 ED visits for IDs was calculated in elderly U.S. adults. This accounted for 13.5% (3.1 million visits) of all ED visits of elderly adults; this burden was higher than that for myocardial infarction and congestive heart failure combined. The rate of ID-related ED visits was 7,231 per 100,000 elderly adults. The most-common diagnoses were lower respiratory infections (26.2%; 95% confidence interval (CI)=25.7-26.6%), urinary tract infections (25.3%, 95% CI=25.0-25.7%), and septicemia (18.9%, 95% CI=18.3-19.6%). Of all ID-related ED visits, 1,786,657 (57.2%, 95% CI=56.6-57.7%) resulted in hospitalization. The leading cause of hospitalization was septicemia, accounting for 32.2% (95% CI=31.1-33.3%) of all ID-related hospitalizations through EDs, followed by lower respiratory infections (27.8%, 95% CI=27.2-28.4%). Overall, 123,894 individuals (4.0%, 95% CI=3.8-4.1%) died during their ED visit or hospitalization. Of these, septicemia was the leading cause of mortality (74.7%, 95% CI=73.8-75.6%), followed by lower respiratory infections (15.2%, 95% CI=14.6-15.9%). Analysis of the 2011 data gave similar results for the burden of ID-related ED visits, hospitalizations, and mortality. CONCLUSION Using a nationally representative sample, it was found that the public health burden of IDs in elderly U.S. adults was substantial, as measured by ED visits, subsequent hospitalizations, and hospital-based mortality.
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Affiliation(s)
- Tadahiro Goto
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kazuki Yoshida
- Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Yusuke Tsugawa
- Harvard Interfaculty Initiative in Health Policy, Harvard University, Boston, Massachusetts
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Analysis of emergency department visits by elderly patients in an urban public hospital in Turkey. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jcgg.2014.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance. Am J Emerg Med 2014; 32:623-8. [DOI: 10.1016/j.ajem.2014.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/15/2014] [Accepted: 03/16/2014] [Indexed: 11/18/2022] Open
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Ng S, Morgan RO, Walder A, Biswas J, Bass DM, Judge KS, Snow AL, Wilson N, Kunik ME. Functional Decline Predicts Emergency Department Use in Veterans With Dementia. Am J Alzheimers Dis Other Demen 2014; 29:362-71. [PMID: 24413540 PMCID: PMC10852555 DOI: 10.1177/1533317513518655] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND We examined emergency room (ER) utilization by persons with dementia (PWDs) using caregiver and patient characteristics as predictors. METHODS A secondary analysis of 296 veteran-caregiver dyads. Caregivers recorded PWD baseline characteristics and noted ER visits over the next year. Two sets of regression models analyzed categorical ER use and repeat ER use. RESULTS In the univariate analysis, categorical use of the ER was predicted by patients' functional status (P ≤ .008) and Veterans Affairs priority grouping (P ≤ .02). Repeat ER admissions were predicted by functional status (P ≤ .04), number of chronic conditions (P ≤ .01), and caregiver-reported relationship strain (P ≤ .04). In multivariate analysis, categorical ER use was predicted by functional status (P ≤ .02), priority grouping (P ≤ .03), and number of chronic conditions (P ≤ .06). CONCLUSIONS Functional status most strongly predicted ER use, highlighting the promise of home-based interventions to improve activities of daily living. Number of chronic conditions and caregiver-reported relationship strain are potential targets of intervention during discharge process.
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Affiliation(s)
- Stephanie Ng
- Baylor College of Medicine, Houston, TX, USA Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
| | - Robert O Morgan
- Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX, USA
| | - Annette Walder
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Jonmenjoy Biswas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - David M Bass
- Margaret Blenkner Research Institute, Benjamin Rose Institute, Cleveland, OH, USA
| | - Katherine S Judge
- Department of Psychology, Cleveland State University, Cleveland, OH, USA
| | - A Lynn Snow
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | - Nancy Wilson
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA VA South Central Mental Illness Research, Education and Clinical Center, USA
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Wierenga PC, Buurman BM, Parlevliet JL, van Munster BC, Smorenburg SM, Inouye SK, de Rooij SEJA. Association between acute geriatric syndromes and medication-related hospital admissions. Drugs Aging 2013; 29:691-9. [PMID: 22812539 DOI: 10.2165/11632510-000000000-00000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Elderly patients are at a 4-fold higher risk of adverse drug events (ADEs) and drug-related hospitalization. Hospitalization of an elderly patient is often preceded by geriatric syndromes, like falls or delirium. OBJECTIVES The primary aim of this study was to investigate whether geriatric syndromes were associated with ADEs in acutely admitted elderly patients. METHODS Consecutive medical patients, aged 65 years or more, who were acutely admitted, were enrolled. An initial multidisciplinary evaluation was completed and baseline characteristics were collected. A fall before admission was retrieved from medical charts. Delirium was determined by the Confusion Assessment Method. RESULTS A total of 641 patients were included. Over 25% had an ADE present at admission, 26% presented with delirium and 12% with a fall. Delirium was associated with the use of antidepressants, antipsychotics and antiepileptics. In all ADEs (n = 167), ADEs were associated with a fall, with non-steroidal anti-inflammatory drugs or diuretics, but not with pre-existing functioning, delirium or older age. For ADEs involving psychoactive medication (n = 35), an association was found between delirium, falls, opioids and antipsychotics in bivariate analyses. A fall just before hospitalization (odds ratio [OR] 3.69 [95% CI 1.41, 9.67]), antipsychotics (OR 3.70 [95% CI 1.19, 11.60]) and opioids (OR 14.57 [95% CI 2.02, 105.30]) remained independently associated with an ADE involving psychoactive medication. CONCLUSION This prospective study demonstrated that, in a cohort of elderly hospital patients, a fall before admission and prevalent delirium are associated with several pharmacological groups and/or with ADE-related hospital admission.
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Affiliation(s)
- Peter C Wierenga
- Department of Clinical Pharmacy, Academic Medical Center, Amsterdam, the Netherlands
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Wierenga PC, Buurman BM, Parlevliet JL, van Munster BC, Smorenburg SM, Inouye SK, de Rooij SEJA. Association between Acute Geriatric Syndromes and Medication-Related Hospital Admissions. Drugs Aging 2012. [DOI: 10.1007/bf03262284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ryan D, Liu B, Awad M, Wong K. Improving older patients’ experience in the emergency room: the senior-friendly emergency room. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.78] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Frail seniors present a unique and growing challenge to emergency healthcare providers because of the complexity of their health conditions, the atypical nature of their presentations, the lack of frailty-focused knowledge and ageism. As a result, elderly patients are more likely to experience adverse events and negative health outcomes than younger people. Fortunately, research in this area has grown dramatically over the last few decades bringing opportunities to improve the elderly patient’s experience in the emergency room. In the present article we use a framework for building more senior-friendly hospitals to review these developments in five key domains – processes of care, the emotional and behavioral environment, ethics in care and research, the physical environment, and organizational support.
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Affiliation(s)
| | - Barbara Liu
- Regional Geriatric Program of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Marlene Awad
- Regional Geriatric Program of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Ken Wong
- Regional Geriatric Program of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
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Samaras N, Chevalley T, Samaras D, Gold G. Older Patients in the Emergency Department: A Review. Ann Emerg Med 2010; 56:261-9. [PMID: 20619500 DOI: 10.1016/j.annemergmed.2010.04.015] [Citation(s) in RCA: 390] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 03/18/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
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Ferron C. L’évaluation gériatrique standardisée en dix points. Rev Mal Respir 2007; 24:785-6. [PMID: 17632437 DOI: 10.1016/s0761-8425(07)91152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- C Ferron
- Service de Médecine Gériatrique, CHU Saint-Etienne, Hôpital Bellevue, Saint-Etienne, France.
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