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Gagliano M, Bula CJ, Seematter-Bagnoud L, Michalski-Monnerat C, Nguyen S, Carron PN, Mabire C. Older patients referred for geriatric consultation in the emergency department: characteristics and healthcare utilization. BMC Geriatr 2023; 23:642. [PMID: 37817072 PMCID: PMC10565963 DOI: 10.1186/s12877-023-04321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is difficult to perform in the emergency department (ED) environment and performance of screening tools in identifying vulnerable older ED patients who are best candidates for a geriatric consultation remain questionable. AIM To determine the characteristics of older patients referred for a geriatric consultation by ED staff and to investigate these patients' subsequent healthcare utilization. METHODS Secondary analysis of data previously collected for a prospective observational study of patients aged 75 + years visiting the ED of an academic hospital in Switzerland over four months (Michalski-Monnerat et al., J Am Geriatr Soc 68(12):2914-20, 2020). Socio-demographic, health, functional (basic activities of daily living; BADL), cognitive, and affective status data were collected at admission by a research nurse using a standardized brief geriatric assessment. Information on geriatric consultations, hospitalization, discharge destination, and 30-day readmission were retrieved from hospital database. Bivariable and multivariable analyses were performed using this data set collected previously. RESULTS Thirty-two (15.8%) of the 202 enrolled patients were referred for a geriatric consultation. Compared to the others, they were older (84.9 ± 5.4 vs 82.9 ± 5.4 years, p = .03), more impaired in BADL (4.8 ± 1.6 vs 5.5 ± 1.0, p = .01), with more comorbid conditions (5.3 ± 1.5 vs 4.5 ± 1.9, p = .03), more frequently admitted after a fall (43.7% vs 19.4%, p = .01), and hospitalized over the previous 6-month period (53.1% vs 30.6%, p = .02). Multivariable analyses that adjusted for variables significantly associated with outcomes in bivariable analysis found that being admitted after a fall (AdjOR 4.0, 95%CI 1.7-9.4, p < .01) and previously hospitalized (AdjOR 2.7, 95% CI 1.2-6.2, p = .02) remained associated with increased odds of consultation, whereas the inverse association with BADL performance remained (AdjOR 0.7, 95%CI 0.5-0.9, p = .01). Patients referred for geriatric consultation had higher odds of hospitalization (84.4% vs 49.4%; AdjOR 5.9, 95%CI 2.1-16.8, p < .01), but similar odds of home discharge when admitted, and of 30-day readmission. CONCLUSION About one in six older ED patients were referred for a geriatric consultation who appeared to be those most vulnerable, as suggested by their increased hospitalization rate. Alternative strategies are needed to enhance access to geriatric consultation in the ED.
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Affiliation(s)
- Mariangela Gagliano
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland.
- Department of Geriatrics, Rehabilitation and Palliative Care, Neuchâtel Hospital Network, Rue du Chasseral 20, La Chaux-de-Fonds, CH-2300, Switzerland.
| | - Christophe J Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
| | - Carole Michalski-Monnerat
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, Neuchâtel, CH-2000, Switzerland
- Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital and University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
| | - Sylvain Nguyen
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Chemin de Mont Paisible 16, Lausanne, CH-1011, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne, CH-1011, Switzerland
| | - Cédric Mabire
- Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital and University of Lausanne, Route de la Corniche 10, Lausanne, CH-1010, Switzerland
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Vuilleumier S, Spichiger T, Dénéréaz S, Fiorentino A. Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines. BMC Emerg Med 2023; 23:4. [PMID: 36635638 PMCID: PMC9836922 DOI: 10.1186/s12873-023-00772-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The pandemic has impacted both patients infected by the SARS-CoV-2 virus and patients who seek emergency assistance due to other health issues. Changes in emergency demands are expected to have occurred during the pandemic, the objective of this investigation is to characterize the changes in ambulance emergency demands during the first year of the COVID-19 pandemic in the Vaud State of Switzerland. The goal of this research is to identify the collateral effects of the COVID-19 pandemic on emergency demands. To do so, this study quantifies the differences in health issues, level of severity, and patients' sociodemographic characteristics (age, location, gender) prior to and during the outbreak. METHOD This is a retrospective, descriptive and comparative statistical analysis of all ambulance emergency missions from 2018 to 2020 (n = 107,150) in the State of Vaud in Switzerland. Variables analyzed were the number of ambulance missions, patient age and gender, health issues, severity (NACA scores), number of non-transports, mission times and locations. Variables were compared between prepandemic and pandemic situations across years and months. Comparative analysis used bivariate analysis, χ2 test, Student's t test, and Mann‒Whitney U test. RESULTS The pandemic has had two major impacts on the population's emergency demands. The first appears to be due to COVID-19, with an increase in respiratory distress cases that doubled in November 2020. The second relates to the implementation of lockdown and quarantine measures for the population and the closures of restaurants and bars. These might explain the decrease in both the number of traumas and intoxications, reaching more than 25% and 28%, respectively. An increase in prehospital emergency demands by the older population, which accounted for 53% of all demands in 2020, is measured. CONCLUSION Collateral effects occurred during 2020 and were not only due to the pandemic but also due to protective measures deployed relative to the population. This work suggests that more targeted reflections and interventions concerning the most vulnerable group, the population of people 65 and older, should be of high priority. Gaining generalizable knowledge from the COVID-19 pandemic in prehospital settings is critical for the management of future pandemics or other unexpected disasters.
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Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
| | - Thierry Spichiger
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Sandrine Dénéréaz
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
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Emergency department use and length of stay by younger and older adults: Nottingham cohort study in the emergency department (NOCED). Aging Clin Exp Res 2022; 34:2873-2885. [PMID: 36074240 PMCID: PMC9453701 DOI: 10.1007/s40520-022-02226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Younger and older adults attending the Emergency Department (ED) are a heterogeneous population. Longer length of ED stay is associated with adverse outcomes and may vary by age. AIMS To evaluate the associations between age and (1) clinical characteristics and (2) length of ED stay among adults attending ED. METHODS The NOttingham Cohort study in the Emergency Department (NOCED)-a retrospective cohort study-comprises new consecutive ED attendances by adults ≥ 18 years, at a secondary/tertiary care hospital, in 2019. Length of ED stay was dichotomised as < 4 and ≥ 4 h. The associations between age and length of ED stay were analysed by binary logistic regression and adjusted for socio-demographic and clinical factors including triage acuity. RESULTS 146,636 attendances were analysed; 75,636 (51.6%) resulted in a length of ED stay ≥ 4 h. Attendances of adults aged 65 to 74 years, 75 to 84 years and ≥ 85 years, respectively, had an increased risk (odds ratio (95% confidence interval) of length of ED stay ≥ 4 h of 1.52 (1.45-1.58), 1.65 (1.58-1.72), and 1.84 (1.75-1.93), compared to those of adults 18 to 64 years (all p < 0.001). These findings remained consistent in the subsets of attendances leading to hospital admission and those leading to discharge from ED. DISCUSSION AND CONCLUSION In this real-world cohort study, older adults were more likely to have a length of ED stay ≥ 4 h, with the oldest old having the highest risk. ED target times should take into account age of attendees.
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Health care utilization in very advanced ages: A study on predisposing, enabling and need factors. Arch Gerontol Geriatr 2021; 98:104561. [PMID: 34706319 DOI: 10.1016/j.archger.2021.104561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022]
Abstract
This study aims to examine the effects of predisposing, enabling, and need factors on healthcare utilization in advanced age. Data from a sample of 270 Portuguese community-dwelling persons aged ≥80 years was used. Face-to-face interviews were conducted and included the application of a research protocol addressing a set of sociodemographic and health-related variables that expressed the Andersen Behavioral model (i.e., predisposing, enabling, and need factors). Predictors of visits to general practitioners (GP) and specialist physicians, as well as emergency department (ED) use and hospitalizations were investigated. Multivariate linear and logistic regression analyzes were used to model the effects of predictor factors specified in the Andersen Behavioral model. Our findings underscore that younger age and having multimorbidity were significantly associated with having GP visits. Specialist physician visits were associated with younger age and a higher number of daily medications. ED use was associated with being male, having formal social support and a higher number of daily medications. Hospitalizations were associated with being younger, being male and having multimorbidity. Our findings revealed that need and predisposing factors determined the most healthcare use.
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Ansah JP, Chiu CT, Wei-Yan AC, Min TLS, Matchar DB. Trends in functional disability and cognitive impairment among the older adult in China up to 2060: estimates from a dynamic multi-state population model. BMC Geriatr 2021; 21:380. [PMID: 34157986 PMCID: PMC8218480 DOI: 10.1186/s12877-021-02309-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background Available evidence suggests that cognitive impairment (CI), which leads to deficits in episodic memory, executive functions, visual attention, and language, is associated with difficulties in the capacity to perform activities of daily living. Hence any forecast of the future prevalence of functional disability should account for the likely impact of cognitive impairment on the onset of functional disability. Thus, this research aims to address this gap in literature by projecting the number of older adults in China with functional disability and cognitive impairment while accounting for the impact of cognitive impairment on the onset of functional disability. Methods We developed and validated a dynamic multi-state population model which simulates the population of China and tracks the transition of Chinese older adults (65 years and older) from 2010 to 2060, to and from six health states—(i) active older adults without cognitive impairment, (ii) active older adults with cognitive impairment, (iii) older adults with 1 to 2 ADL limitations, (iv) older adults with cognitive impairment and 1 to 2 ADL limitations, (v) older adults with 3 or more ADL limitations, and (vi) older adults with cognitive impairment and 3 or more ADL limitations. Results From 2015 to 2060, the number of older adults 65 years and older in China is projected to increase, of which the number with impairment (herein referred to as individuals with cognitive impairment and/or activity of daily living limitations) is projected to increase more than fourfold from 17·9 million (17·8–18·0) million in 2015 to 96·2 (95·3–97·1) million by 2060. Among the older adults with impairment, those with ADL limitations only is projected to increase from 3·7 million (3·6–3·7 million) in 2015 to 23·9 million (23·4–24·6 million) by 2060, with an estimated annual increase of 12·2% (12·1–12·3); while that for cognitive impairment only is estimated to increase from 11·4 million (11·3–11·5 million) in 2015 to 47·8 million (47·5–48·2 million) by 2060—this representing an annual growth of 7·07% (7·05–7·09). Conclusion Our findings suggest there will be an increase in demand for intermediate and long-term care services among the older adults with functional disability and cognitive impairment. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02309-4.
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Affiliation(s)
| | - Chi-Tsun Chiu
- Institute of European and American Studies Academia Sinica, Taipei, Taiwan
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Vuilleumier S, Fiorentino A, Dénéréaz S, Spichiger T. Identification of new demands regarding prehospital care based on 35,188 missions in 2018. BMC Emerg Med 2021; 21:63. [PMID: 34030660 PMCID: PMC8142491 DOI: 10.1186/s12873-021-00456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care. The prehospital system is facing an increase of cases without acute threat to life (so-called "non-urgent"), which generates tension due to a higher number of admissions to emergency departments and a greater use of prehospital resources. Our aim is to understand this transition in prehospital activities and to delineate the primary missions performed by paramedics in 2018 with a focus on the population concerned, the severity of cases encountered and the typology of health issues. METHOD The study is retrospective, and descriptive, using a statistical description of 35,188 primary missions realized in 2018 in the State of Vaud (Switzerland). The characteristics taken into consideration are the age and gender of patients, as well as the health issue, the severity of cases based on National Advisory Committee for Aeronautics score (NACA score), and the time and place of intervention. RESULTS The results describe the primary missions in the State of Vaud in 2018 and show that 87% of missions concern "non-urgent" situations (without acute threat to life). Over half of patients are 65 or older, the highest proportion of health issues, 49%, are medical and only 23% of missions are for traumas. Mission related to mental health issues reach 7% and those for intoxication 6%. Most missions take place between 7:00 am and 6:00 pm (67%), and around 12% of missions lead to the non-transport of the patient. CONCLUSION The prehospital sector is confronted with a major transition in terms of patient care. An increase of non-urgent cases is observed, associated with the care of persons aged 65 or more. Our results question the adequacy between the needs in terms of prehospital care and the paramedic profession as it is currently defined, as well as the place of this profession within the health network. Reflecting upon the role of paramedics with respect to the socio-demographic evolution of populations appears necessary, to analyse the adequacy of the paramedics' skills to respond to the current needs.
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Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), CH-1004, Lausanne, Switzerland.
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), CH-1004, Lausanne, Switzerland
| | - Sandrine Dénéréaz
- Vocational Training College for Registered Paramedics and Emergency Care, ES ASUR, CH-1052, Le Mont-sur-Lausanne, Switzerland
| | - Thierry Spichiger
- Vocational Training College for Registered Paramedics and Emergency Care, ES ASUR, CH-1052, Le Mont-sur-Lausanne, Switzerland
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Gomes JCP, Dias RD, de Barros JV, Velasco IT, Jacob Filho W. The growing impact of older patients in the emergency department: a 5-year retrospective analysis in Brazil. BMC Emerg Med 2020; 20:47. [PMID: 32527325 PMCID: PMC7291438 DOI: 10.1186/s12873-020-00341-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we know, no other study in Latin America has analyzed the impact of demographic changes in tertiary ED attendance. AIM To describe the sociodemographic characteristics and outcomes of tertiary Brazilian ED users. METHODS Design: Observational cross-sectional analytic study. SETTING Emergency Department, tertiary university hospital, São Paulo, Brazil. PARTICIPANTS patients aged 18 years or older attending a tertiary ED (2009-2013). The primary outcomes were hospitalization and mortality; the secondary outcome was ICU admission. Age was categorized as 'young adults' (18-39y), 'adults' (40-59y), 'young-older adults' (60-79y), and 'old-older adults' (80-109y). Other variables included sex, reason for attendance, time of ED visit, mode of presentation, type of hospitalization, main procedure, length of hospital stay (LOS) and length of ICU stay (ICU-LOS). We calculated descriptive statistics, built generalized linear mixed models for each outcome and estimated Odds Ratios (95% CI) for the independent categorical variables. The significance level was 5% with Bonferroni correction. RESULTS Older age-groups represented 26.6% of 333,028 ED visits, 40.7% of admissions, 42.7% of ICU admissions and 58% of all deaths. Old-older patients accounted for 5.1% of ED visits, 9.5% of admissions and 10.1% of ICU admissions. Hospitalization, ICU admission and mortality rates increased with older age in both sexes. LOS and ICU-LOS were similar across age-groups. The proportions of visits and admissions attributed to young adults decreased annually, while those of people aged 60 or over increased. The ORs for hospitalization, ICU admission and mortality associated with the old-older group were 3.49 (95% CI = 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference. CONCLUSIONS In tertiary ED, age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification.
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Affiliation(s)
- João Carlos Pereira Gomes
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil.
| | - Roger Daglius Dias
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
| | - Jacson Venancio de Barros
- Department of Information Technology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Irineu Tadeu Velasco
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr. Enéas Carvalho de Aguiar, 255, 5° andar, s.5023, São Paulo, SP, CEP: 05403-010, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob Filho
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- Division of Geriatrics, Department of Internal Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Hesselink G, Sir Ö, Öztürk E, Heiwegen N, Olde Rikkert M, Schoon Y. Effects of a geriatric education program for emergency physicians: a mixed-methods study. HEALTH EDUCATION RESEARCH 2020; 35:216-227. [PMID: 32243526 PMCID: PMC7568505 DOI: 10.1093/her/cyaa007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
Emergency physicians (EPs) often regard care for older adults as complex, while they lack sufficient geriatric skills. This study evaluates the effect of a geriatric education program on EPs' geriatric knowledge, attitude and medical practice when treating older adults. A mixed-methods study was performed on EPs from two Dutch hospitals. Effects were measured by pre-post tests of EPs' (n = 21) knowledge of geriatric syndromes and attitudes toward older adults, and by a retrospective pre-post analysis of 100 records of patients aged 70 years or more. Six EPs were purposively sampled and interviewed after completion of the education program. The program significantly improved EPs' geriatric knowledge. EPs indicated that the program improved their ability and attentiveness to recognize frailty and geriatric syndromes. The program also significantly improved EPs' attention for the older patient's social history and circumstances (P = 0.04) but did not have a significant effect on medical decision making. EPs valued especially the case-based teaching and indicated that the interactive setting helped them to better understand and retain knowledge. Combined quantitative and qualitative data suggest that EPs benefit from geriatric emergency teaching. Future enhancement and evaluation of the geriatric education program is needed to confirm benefits to clinical practice and patient outcomes.
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Affiliation(s)
- Gijs Hesselink
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Health Care, Nijmegen, The Netherlands
| | - Özcan Sir
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ekin Öztürk
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nikki Heiwegen
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Schoon
- Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Chen C, Lim JT, Chia NC, Wang L, Tysinger B, Zissimopolous J, Chong MZ, Wang Z, Koh GC, Yuan JM, Tan KB, Chia KS, Cook AR, Malhotra R, Chan A, Ma S, Ng TP, Koh WP, Goldman DP, Yoong J. The Long-Term Impact of Functional Disability on Hospitalization Spending in Singapore. JOURNAL OF THE ECONOMICS OF AGEING 2019; 14:100193. [PMID: 31857943 PMCID: PMC6922027 DOI: 10.1016/j.jeoa.2019.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 elders in Singapore will have at least one ADL disability and 1 in 3 elders will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.
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Affiliation(s)
- C Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - JT Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - NC Chia
- Department of Economics, National University of Singapore, Singapore
| | - L Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - B Tysinger
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - J Zissimopolous
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - MZ Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Z Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - GC Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - JM Yuan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - KB Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Policy Research and Economics Office, Ministry of Health, Singapore
| | - KS Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - AR Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - R Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - A Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - S Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore
| | - TP Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - WP Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - DP Goldman
- Schaeffer Center for Health Policy and Economics, University of Southern California, USA
| | - J Yoong
- Center for Economic and Social Research, University of Southern California, USA
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Fuchs C, Çelik B, Brouns SHA, Kaymak U, Haak HR. No age thresholds in the emergency department: A retrospective cohort study on age differences. PLoS One 2019; 14:e0210743. [PMID: 30699209 PMCID: PMC6353140 DOI: 10.1371/journal.pone.0210743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/31/2018] [Indexed: 11/26/2022] Open
Abstract
Emergency care in elderly patients has gained attention by researchers due to high utilization rate and the importance of emergency services in elderly care. We examine if there is a clear age threshold between young and old patients at which there is a need for extra care and facilities in the emergency department. This retrospective cohort study uses emergency department (ED) data collected over the course of a year, containing information about 31,491 patient visits. The measured variables are treatment time, waiting time, number of tests, number of medical procedures, number of specialties involved and the patient’s length of stay on the ED. To examine the multivariate differences between different patient groups, the data set is split into eighteen age groups and a MANOVA analysis is conducted to compare group means. The results show that older patients tend to have a longer stay on the ED. They also require more medical tests, have higher resource utilization and admission rates to the hospital. When the patients are grouped according to life stages (<18, 18-39, 40-64 and ≥65), each life stage shows significantly different characteristics across all variables. To understand where these differences start, age bins of five years are analyzed and almost none of the consecutive groups are significantly different in any variable. A significant difference between all groups is observed when age interval of the bins is increased to 10 years. This indicates that although age has an effect on the patient’s treatment, a clear age threshold that identifies the group of elderly patients is not observable from emergency room variables. The results of this study show no clear age boundary between young and old patients. In other words, we could not find support for favoring the often-used age boundary of 65 over other boundaries (e.g. 60 or 70) to distinguish the group of elderly patients on the ED.
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Affiliation(s)
- Caro Fuchs
- Eindhoven University of Technology, School of Industrial Engineering, Eindhoven, The Netherlands
- * E-mail:
| | - Bilge Çelik
- Eindhoven University of Technology, School of Industrial Engineering, Eindhoven, The Netherlands
| | - Steffie H. A. Brouns
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, the Netherlands
| | - Uzay Kaymak
- Eindhoven University of Technology, School of Industrial Engineering, Eindhoven, The Netherlands
| | - Harm R. Haak
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, the Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Ageing and Long-Term Care, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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11
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Tanderup A, Lassen AT, Rosholm JU, Ryg J. Disability and morbidity among older patients in the emergency department: a Danish population-based cohort study. BMJ Open 2018; 8:e023803. [PMID: 30552269 PMCID: PMC6303572 DOI: 10.1136/bmjopen-2018-023803] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The objective was to describe the prevalence of geriatric conditions among older medical patients in the emergency department (ED) and the association with admission, mortality, reattendance and loss of independency. DESIGN Population-based prospective cohort study. SETTING ED of a large university hospital. PARTICIPANTS All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014). PRIMARY AND SECONDARY OUTCOME MEASURES Based on information from healthcare registers, we defined geriatric conditions as disability, recently increased disability, polypharmacy and comorbidity. Outcomes were admission, length of admission, 30 days postdischarge mortality, 30 days hospital reattendance and home care dependency 0-360 days following ED contact. RESULTS Totally, 3775 patients (55% women) were included, age 78 (71-85) years (median (IQR)). No patients were lost to follow-up. The prevalence of 0-4 geriatric conditions was 14.9%, 27.3%, 25.2%, 22.3% and 10.3%, respectively. The number of conditions was significantly associated with hospital admission, length of admission, 30 days postdischarge mortality and 30 days hospital reattendance. Among patients with no geriatric conditions, 70% lived independent all 360 days after discharge, whereas all patients with ≥3 conditions had some dependency or were dead within 360 days following discharge. CONCLUSION Among older medical patients in the ED, 50% had two or more geriatric conditions which were associated with poor health outcomes. This highlights the need for studies of the effect of geriatric awareness and competences in the ED.
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Affiliation(s)
- Anette Tanderup
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Jens-Ulrik Rosholm
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Vilpert S, Monod S, Jaccard Ruedin H, Maurer J, Trueb L, Yersin B, Büla C. Differences in triage category, priority level and hospitalization rate between young-old and old-old patients visiting the emergency department. BMC Health Serv Res 2018; 18:456. [PMID: 29907110 PMCID: PMC6003168 DOI: 10.1186/s12913-018-3257-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 05/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Emergency Department (ED) are challenged by the increasing number of visits made by the heterogeneous population of elderly persons. This study aims to 1) compare chief complaints (triage categories) and level of priority; 2) to investigate their association with hospitalization after an ED visit; 3) to explore factors explaining the difference in hospitalization rates among community-dwelling older adults aged 65–84 vs 85+ years. Methods All ED visits of patients age 65 and over that occurred between 2005 and 2010 to the University of Lausanne Medical Center were analyzed. Associations of hospitalization with triage categories and level of priority using regressions were compared between the two age groups. Blinder-Oaxaca decomposition was performed to explore how much age-related differences in prevalence of priority level and triage categories contributed to predicted difference in hospitalization rates across the two age groups. Results Among 39′178 ED visits, 8′812 (22.5%) occurred in 85+ patients. This group had fewer high priority and more low priority conditions than the younger group. Older patients were more frequently triaged in “Trauma” (20.9 vs 15.0%) and “Home care impossible” (10.1% vs 4.2%) categories, and were more frequently hospitalized after their ED visit (69.1% vs 58.5%). Differences in prevalence of triage categories between the two age groups explained a quarter (26%) of the total age-related difference in hospitalization rates, whereas priority level did not play a role. Conclusions Prevalence of priority level and in triage categories differed across the two age groups but only triage categories contributed moderately to explaining the age-related difference in hospitalization rates after the ED visit. Indeed, most of this difference remained unexplained, suggesting that age itself, besides other unmeasured factors, may play a role in explaining the higher hospitalization rate in patients aged 85+ years. Electronic supplementary material The online version of this article (10.1186/s12913-018-3257-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Vilpert
- FORS Swiss Centre of Expertise in Social Sciences, University of Lausanne, Géopolis, 1015, Lausanne, Switzerland.
| | - Stéfanie Monod
- Public Health Department of the Canton of Vaud, Av. des Casernes 2, Lausanne, 1014, Switzerland
| | - Hélène Jaccard Ruedin
- Réseau Santé Nord Broye, Center for Community Geriatrics, Av. des Sciences 1, 1400, Yverdon-les-Bains, Switzerland
| | - Jürgen Maurer
- Department of Economics, University of Lausanne, Internef, 1015, Lausanne, Switzerland
| | - Lionel Trueb
- Service of Emergency Medicine, University of Lausanne Medical Center (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Bertrand Yersin
- Service of Emergency Medicine, University of Lausanne Medical Center (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Medical Center (CHUV), Mont-Paisible 16, 1011, Lausanne, Switzerland
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13
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Le Pogam MA, Quantin C, Reich O, Tuppin P, Fagot-Campagna A, Paccaud F, Peytremann-Bridevaux I, Burnand B. Geriatric Patient Safety Indicators Based on Linked Administrative Health Data to Assess Anticoagulant-Related Thromboembolic and Hemorrhagic Adverse Events in Older Inpatients: A Study Proposal. JMIR Res Protoc 2017; 6:e82. [PMID: 28495660 PMCID: PMC5445236 DOI: 10.2196/resprot.7562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Frail older people with multiple interacting conditions, polypharmacy, and complex care needs are particularly exposed to health care-related adverse events. Among these, anticoagulant-related thromboembolic and hemorrhagic events are particularly frequent and serious in older inpatients. The growing use of anticoagulants in this population and their substantial risk of toxicity and inefficacy have therefore become an important patient safety and public health concern worldwide. Anticoagulant-related adverse events and the quality of anticoagulation management should thus be routinely assessed to improve patient safety in vulnerable older inpatients. Objective This project aims to develop and validate a set of outcome and process indicators based on linked administrative health data (ie, insurance claims data linked to hospital discharge data) assessing older inpatient safety related to anticoagulation in both Switzerland and France, and enabling comparisons across time and among hospitals, health territories, and countries. Geriatric patient safety indicators (GPSIs) will assess anticoagulant-related adverse events. Geriatric quality indicators (GQIs) will evaluate the management of anticoagulants for the prevention and treatment of arterial or venous thromboembolism in older inpatients. Methods GPSIs will measure cumulative incidences of thromboembolic and bleeding adverse events based on hospital discharge data linked to insurance claims data. Using linked administrative health data will improve GPSI risk adjustment on patients’ conditions that are present at admission and will capture in-hospital and postdischarge adverse events. GQIs will estimate the proportion of index hospital stays resulting in recommended anticoagulation at discharge and up to various time frames based on the same electronic health data. The GPSI and GQI development and validation process will comprise 6 stages: (1) selection and specification of candidate indicators, (2) definition of administrative data-based algorithms, (3) empirical measurement of indicators using linked administrative health data, (4) validation of indicators, (5) analyses of geographic and temporal variations for reliable and valid indicators, and (6) data visualization. Results Study populations will consist of 166,670 Swiss and 5,902,037 French residents aged 65 years and older admitted to an acute care hospital at least once during the 2012-2014 period and insured for at least 1 year before admission and 1 year after discharge. We will extract Swiss data from the Helsana Group data warehouse and French data from the national health insurance information system (SNIIR-AM). The study has been approved by Swiss and French ethics committees and regulatory organizations for data protection. Conclusions Validated GPSIs and GQIs should help support and drive quality and safety improvement in older inpatients, inform health care stakeholders, and enable international comparisons. We discuss several limitations relating to the representativeness of study populations, accuracy of administrative health data, methods used for GPSI criterion validity assessment, and potential confounding bias in comparisons based on GQIs, and we address these limitations to strengthen study feasibility and validity.
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Affiliation(s)
- Marie-Annick Le Pogam
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital and University of Bourgogne Franche-Comté, Dijon, France.,Inserm, CIC 1432, Clinical epidemiology / clinical trials unit, Dijon University Hospital, Dijon, France.,Inserm, UMR 1181, B2PHI: Biostatistics, Biomathematics, PHarmacoepidemiology and Infectious diseases, Institut Pasteur and Université de Versailles St-Quentin-en-Yvelines, Université Paris-Saclay, Paris, France
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Philippe Tuppin
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Anne Fagot-Campagna
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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14
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Brandão D, Ribeiro O, Freitas A, Paúl C. Hospital admissions by the oldest old: Past trends in one of the most ageing countries in the world. Geriatr Gerontol Int 2017; 17:2255-2265. [PMID: 28276619 DOI: 10.1111/ggi.13006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/16/2016] [Accepted: 12/26/2016] [Indexed: 01/19/2023]
Abstract
AIM To examine discharges of octogenarians, nonagenarians and centenarians from Portuguese public hospitals, namely admission type, principal diagnoses, comorbidities and length of stay. METHODS The present study used administrative data from public acute care hospitals in the Portuguese National Health Service. All discharges of persons aged ≥80 years between 2000 and 2014 were analyzed. HCUP Clinical Classifications Software was considered to aggregate principal diagnosis, and comorbidities were assessed using the Charlson Comorbidity Index computed using International Classification of Diseases 9th Revision Clinical Modification codes. RESULTS A total of 2 494 924 discharges of persons aged 80 years or older were registered. Most (73.7%) referred to inpatient episodes, of which 73% were unplanned and medical (non-surgical). Pneumonia (12.2%), acute cerebrovascular disease (7.1%) and non-hypertensive cardiac heart failure (5.3%) were the most common principal diagnoses among inpatient episodes. Congestive heart failure and diabetes without chronic complications were the two most frequent comorbidities (16.6%), and discharge diagnoses with higher median length of stay were tuberculosis, burns, and infective arthritis and osteomyelitis. CONCLUSIONS The number of hospitalizations of the oldest old has suffered a significant increase in the past few years, reinforcing the need for healthcare services being prepared to the specificities of the oldest old population. Geriatr Gerontol Int 2017; 17: 2255-2265.
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Affiliation(s)
- Daniela Brandão
- Research and Education Unit on Aging (UNIFAI/ICBAS-UP), University of Oporto, Oporto, Portugal.,Faculty of Medicine, University of Oporto (FMUP-UP), Oporto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Oporto, Portugal
| | - Oscar Ribeiro
- Research and Education Unit on Aging (UNIFAI/ICBAS-UP), University of Oporto, Oporto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Oporto, Portugal
| | - Alberto Freitas
- Faculty of Medicine, University of Oporto (FMUP-UP), Oporto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Oporto, Portugal
| | - Constança Paúl
- Research and Education Unit on Aging (UNIFAI/ICBAS-UP), University of Oporto, Oporto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Oporto, Portugal
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15
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Carron PN, Mabire C, Yersin B, Büla C. Nursing home residents at the Emergency Department: a 6-year retrospective analysis in a Swiss academic hospital. Intern Emerg Med 2017; 12:229-237. [PMID: 27178709 DOI: 10.1007/s11739-016-1459-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
The increasing number of elderly persons produces an increase in emergency department (ED) visits by these patients, including nursing home (NH) residents. This trend implies a major challenge for the ED. This study sought to investigate ED visits by NH residents in an academic hospital. A retrospective monocentric analysis of all ED visits by NH residents between 2005 and 2010 in a Swiss urban academic hospital. All NH residents aged 65 years and over were included. Socio-demographic data, mode of transfer to ED, triage severity rating, main reason for visit, ED and hospital length of stay, discharge dispositions, readmission at 30 and 90 day were collected. Annual ED visits by NH residents increased by 50 % (from 465 to 698) over the study period, accounting for 1.5 to 1.9 % of all ED visits from 2005 to 2010, respectively. Over the period, yearly rates of ED visits increased steadily from 18.8 to 27.5 per 100 NH residents. Main reasons for ED visits were trauma, respiratory, cardiovascular, digestive, and neurological problems. 52 % were for urgent situations. Less than 2 % of NH residents died during their ED stay and 60 % were admitted to hospital wards. ED use by NH residents disproportionately increased over the period, likely reflecting changes in residents and caregivers' expectations, NH staff care delivery, as well as possible correction of prior ED underuse. These results highlight the need to improve ED process of care for these patients and to identify interventions to prevent potentially unnecessary ED transfers.
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Affiliation(s)
| | - Cédric Mabire
- University of Health Sciences (HESAV), Lausanne, Switzerland
| | - Bertrand Yersin
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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16
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DEMİRCAN A, AYGENCEL BIKMAZ ŞG, KADI G, KELEŞ A, BİLDİK F, ÖKTEM B, ÇAKMAK O. Evaluation of the general characteristics of patients aged 85 years and above admitted to a university hospital emergency department. Turk J Med Sci 2017; 47:1393-1402. [DOI: 10.3906/sag-1701-77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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17
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Tavares V, Carron PN, Yersin B, Taffé P, Burnand B, Pittet V. The probability of having advanced medical interventions is associated with age in out-of-hospital life-threatening situations. Scand J Trauma Resusc Emerg Med 2016; 24:103. [PMID: 27554262 PMCID: PMC4995648 DOI: 10.1186/s13049-016-0294-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/17/2016] [Indexed: 01/11/2023] Open
Abstract
Background The use of out-of-hospital emergency medical services by old and very old individuals is increasing. These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives. In this setting, age may be used as a proxy to determine strategy of care, therapeutic choices or withdrawal of care, particularly in relation to advanced medical interventions. We aimed to determine how an emergency physician’s initiation of out-of-hospital advanced medical interventions varies with the patient’s age. Methods We performed a retrospective analysis of the missions conducted by the emergency physicians-staffed emergency medical services in a Swiss region. We used logistic regression analysis to determine whether the probability of receiving an advanced medical intervention was associated with the patient’s age. Results Among 21,922 out-of-hospital emergency adult missions requiring an emergency physician, the probability of receiving an advanced medical intervention decreased with age. It was highest among those aged 18 – 58 years and significantly lower among those aged ≥ 89 years (OR = 0.66; 95 % CI: 0.53 – 0.82). The probability of cardiopulmonary resuscitation attempts progressively decreased with age and was significantly lower for the three oldest age deciles (80 – 83, 84 – 88 and ≥ 89 years). Conclusion The number of out-of-hospital advanced medical interventions significantly decreased for patients aged ≥ 89 years. It is unknown whether this lower rate of interventions was related only to age or to other medical characteristics of these patients, such as the number or severity of comorbidities. Thus, further studies are needed to confirm whether this observation corresponds to underuse of advanced medical interventions in very old patients.
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Affiliation(s)
- Vania Tavares
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Bertrand Yersin
- Emergency Department, Lausanne University Hospital, CH-1011, Lausanne, Switzerland
| | - Patrick Taffé
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Valérie Pittet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Sims-Gould J, Byrne K, Hicks E, Franke T, Stolee P. "When Things Are Really Complicated, We Call the Social Worker": Post-Hip-Fracture Care Transitions for Older People. HEALTH & SOCIAL WORK 2015; 40:257-265. [PMID: 26638501 DOI: 10.1093/hsw/hlv069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Social workers play a key role in the delivery of interdisciplinary health care. However, in the past decade, concerns have been raised about social work's sustainability and contributions in a changing health care sector. These changes come at a time when older patients are more complex and vulnerable than ever before. In this article, using a strengths-based approach, the authors examine the key contributions made by social workers working with older patients with hip fracture as they strive to achieve successful care transitions. Twenty-five interviews with health care professionals (HCPs) were conducted and then analyzed using an analytical coding framework. Although social workers are vital, they are often underused and overlooked in the care of hip fracture patients. The authors sketch the important contributions that social workers make to care transitions after hip fracture, specifically informational continuity; patient-HCP relational continuity; conflict resolution; mediation among family, patient, and HCP (for example, doctors and nurses); collaboration with family caregivers and community supports; and relocation counseling.
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Abe T, Tamiya N, Kitahara T, Tokuda Y. Polypharmacy as a risk factor for hospital admission among ambulance-transported old-old patients. Acute Med Surg 2015; 3:107-113. [PMID: 29123761 DOI: 10.1002/ams2.153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/03/2015] [Indexed: 11/06/2022] Open
Abstract
Aim The aim of this study was to analyze the relationship between polypharmacy and hospital admission in ambulance-transported old-old patients. Methods A retrospective cohort study was conducted of consecutive old-old patients (aged ≥ 85 years) transported by ambulance to a community teaching hospital between April and December of 2013. Patients with out-of-hospital cardiopulmonary arrest were excluded. Data were collected from the computerized records on the demographics, chief complaints, vital signs, and level of consciousness at arrival, final diagnoses at discharge, and polypharmacy (≥5 medications). The primary outcome was requirement of hospital admission. We also analyzed symptomatic adverse drug events (ADEs). Results Of the 3,084 adults (aged ≥ 18 years) transported to the hospital during the study period, 381 (13%) were old-old patients. Of those, 233 (61%) were women, and 261 (69%) were admitted to the hospital. The mean number of their baseline medications was 6.8 ± 3.9, and 250/347 patients (72%) were suffering from polypharmacy. Twenty-seven of the patients (7%) had symptomatic ADEs. Although the ADEs were not related to polypharmacy (P = 0.437), logistic regression adjustments for age, sex, and vital signs at arrival showed that patients with polypharmacy were more likely to be admitted to the hospital than were patients without (odds ratio: 2.12 [95% CI, 1.03-4.43]; P = 0.042). Conclusions Symptomatic ADEs due to polypharmacy were one of the most preventable causative factors leading to hospital admission of old-old patients. Polypharmacy could be a major risk for emergency admission to hospital.
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Affiliation(s)
- Toshikazu Abe
- Department of Emergency and Critical Care Medicine Tsukuba Medical Center Hospital Tsukuba Japan.,Department of Health Services Research, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Takako Kitahara
- Department of Emergency and Critical Care Medicine Tsukuba Medical Center Hospital Tsukuba Japan
| | - Yasuharu Tokuda
- Department of Medicine Japan Community Healthcare Organization Tokyo Japan
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20
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Golüke N, Huibers C, Stalpers S, Taekema D, Vermeer S, Jansen P. An observational, retrospective study of the length of stay, and its influencing factors, among elderly patients at the Emergency Department. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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de Boissieu P, Mahmoudi R, Hentzien M, Toquet S, Novella JL, Blanchard F, Jolly D, Dramé M. Predictors of Long-Term Mortality in Oldest Old Patients (90+) Hospitalized to Medical Wards via the Emergency Department: The SAFES Cohort. J Nutr Health Aging 2015; 19:702-7. [PMID: 26054508 DOI: 10.1007/s12603-015-0515-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To identify risk factors for long-term mortality in patients aged 90 years and over who are admitted to hospital through the emergency department. DESIGN Prospective cohort study (SAFES cohort; Sujet Agé Fragile - Évaluation Suivi). SETTING 8 university teaching hospitals and one regional, non-academic hospital in France. PARTICIPANTS Among 1306 patients in the SAFES cohort, 291 patients aged 90 or over were included. MEASUREMENTS At inclusion, we recorded socio-demographic data (age, sex, level of education, living alone or in an institution, number of children, presence of helper/caregiver), and data from geriatric evaluation (dependence status, risk of depression, dementia, delirium, nutritional status, walking disorders, risk of falls, comorbidities, risk of pressure sores). Vital status at 36 months was obtained from the treating physician, the general practitioner, administrative registers, or during follow-up consultations. RESULTS Among 291 patients included, 190 (65.3%) had died at 36 months. Risk factors for mortality at 36 months identified by multivariate analysis were risk of malnutrition (HR 1.6, 95%CI 1.1-2.3, p=0.004) and delirium (HR 1.6, 95%CI 1.1-2.3, p=0.01). CONCLUSION Risk of malnutrition and presence of delirium are risk factors for mortality at 36 months in subjects aged 90 years and over hospitalized through the emergency department.
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Affiliation(s)
- P de Boissieu
- Moustapha Dramé, MD, MPH, PhD. Department of Research and Innovation. Reims University Hospitals, Avenue du Général Koenig, 51092 Reims cedex, France. Tel. +33 3 26 78 44 12, Fax. +33 3 26 83 25 89, E-mail.
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Ansah JP, Malhotra R, Lew N, Chiu CT, Chan A, Bayer S, Matchar DB. Projection of young-old and old-old with functional disability: does accounting for the changing educational composition of the elderly population make a difference? PLoS One 2015; 10:e0126471. [PMID: 25974069 PMCID: PMC4431717 DOI: 10.1371/journal.pone.0126471] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/02/2015] [Indexed: 11/18/2022] Open
Abstract
This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.
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Affiliation(s)
- John P. Ansah
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- * E-mail:
| | - Rahul Malhotra
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Nicola Lew
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Chi-Tsun Chiu
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Angelique Chan
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Sociology, National University of Singapore, Singapore, Singapore
| | - Steffen Bayer
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - David B. Matchar
- Signature Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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Pittet V, Burnand B, Yersin B, Carron PN. Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry analysis. BMC Health Serv Res 2014; 14:380. [PMID: 25209450 PMCID: PMC4169798 DOI: 10.1186/1472-6963-14-380] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background The number of requests to pre-hospital emergency medical services (PEMS) has increased in Europe over the last 20 years, but epidemiology of PEMS interventions has little be investigated. The aim of this analysis was to describe time trends of PEMS activity in a region of western Switzerland. Methods Use of data routinely and prospectively collected for PEMS intervention in the Canton of Vaud, Switzerland, from 2001 to 2010. This Swiss Canton comprises approximately 10% of the whole Swiss population. Results We observed a 40% increase in the number of requests to PEMS between 2001 and 2010. The overall rate of requests was 35/1000 inhabitants for ambulance services and 10/1000 for medical interventions (SMUR), with the highest rate among people aged ≥ 80. Most frequent reasons for the intervention were related to medical problems, predominantly unconsciousness, chest pain respiratory distress, or cardiac arrest, whereas severe trauma interventions decreased over time. Overall, 89% were alive after 48 h. The survival rate after 48 h increased regularly for cardiac arrest or myocardial infarction. Conclusion Routine prospective data collection of prehospital emergency interventions and monitoring of activity was feasible over time. The results we found add to the understanding of determinants of PEMS use and need to be considered to plan use of emergency health services in the near future. More comprehensive analysis of the quality of services and patient safety supported by indicators are also required, which might help to develop prehospital emergency services and new processes of care.
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Affiliation(s)
- Valérie Pittet
- Institute of social & preventive medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, CH-1010 Lausanne, Switzerland.
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24
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Leonard C, Bein KJ, Latt M, Muscatello D, Veillard AS, Dinh MM. Demand for emergency department services in the elderly: An 11 year analysis of the Greater Sydney Area. Emerg Med Australas 2014; 26:356-60. [DOI: 10.1111/1742-6723.12250] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Claire Leonard
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Kendall J Bein
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Mark Latt
- Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | | | | | - Michael M Dinh
- Discipline of Emergency Medicine, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
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