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Gagnon S, Nadeau A, Tanguay K, Archambault PM, Brousseau AA, Carmichael PH, Emond M, Deshaies JF, Benhamed A, Blanchard PG, Mowbray FI, Mercier E. Prevalence and predictors of elder abuse among older adults attending emergency departments: a prospective cohort study. CAN J EMERG MED 2023; 25:953-958. [PMID: 37853307 DOI: 10.1007/s43678-023-00600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Elder abuse is associated with impaired physical and psychological health. It is, however, rarely identified in emergency departments (EDs). The objective was to determine the prevalence and the predictors of elder abuse among older adults visiting EDs. METHODS This prospective cohort study was conducted in eight Canadian EDs between May and August 2021. Patients were eligible if they were ≥ 65 years old, oriented to time, and with a Canadian Triage and Acuity Scale score 3, 4 or 5. In a private setting, participants were questioned directly about abuse as part of a larger questionnaire exploring ten non-medical problems. We used multivariable logistic regression to identify predictors of elder abuse. RESULTS A total of 1061 participants were recruited (mean age: 77.1 (SD 7.6) years, female sex: 55.7%, lived alone: 42.5%). Patients mostly attended EDs for pain (19.6%), neurologic (11.3%) or cardiovascular (8.4%) symptoms. The most frequent pre-existing comorbidities were hypertension (67.2%), mental health conditions (33.3%) and cardiac insufficiency (29.6%). Mobility issues outside (41.0%) or inside their home (30.7%) and loneliness (29.4%) were also frequent. Fifty-four (5.1%) participants reported elder abuse, of which 34.3% were aware of available community-based resources. Identified predictors of elder abuse were female sex (OR 2.8 [95%CI 1.4; 5.6]), financial difficulties (OR 3.6 [95%CI 1.8; 7.3]), food insecurity (OR 2.7 [95%CI 1.2; 5.6]), need for a caregiver (OR 2.7 [95%CI 1.5; 5.0]) and at least one pre-existing mental health condition (OR 2.6 [95%CI 1.4; 4.9]). CONCLUSION When questioned directly, 5.1% of older adults attending EDs reported experiencing abuse. Female sex, functional impairment, social vulnerability, and mental health comorbidities are associated with elder abuse. Given its importance and relatively high prevalence, ED professionals should have a low threshold to ask directly about elder abuse.
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Affiliation(s)
- Samuel Gagnon
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
| | - Alexandra Nadeau
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada
| | - Katherine Tanguay
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada
| | - Patrick M Archambault
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada
- Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière Appalaches, Lévis, QC, Canada
| | - Audrey-Anne Brousseau
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine et sciences de la santé, Université de Sherbrooke, Sherbooke, QC, Canada
| | | | - Marcel Emond
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada
| | - Jean-Francois Deshaies
- Centre de recherche intégrée pour un système de santé apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière Appalaches, Lévis, QC, Canada
| | - Axel Benhamed
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hopitaux Civils de Lyon, Lyon, France
| | - Pierre-Gilles Blanchard
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada
| | - Fabrice I Mowbray
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Eric Mercier
- Centre de recherche du CHU de Québec-Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC, Canada.
- VITAM-Centre de recherche en santé durable, Quebec, QC, Canada.
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Quebec, QC, Canada.
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Dufour-Neyron H, Tanguay K, Nadeau A, Emond M, Harrisson J, Robert S, Capolla-Daneau N, Groulx M, Carmichael PH, Mercier E. Prehospital Use of the Esophageal Tracheal Combitube Supraglottic Airway Device: A Retrospective Cohort Study. J Emerg Med 2022; 62:324-331. [PMID: 35067394 DOI: 10.1016/j.jemermed.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/26/2021] [Accepted: 11/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the province of Quebec (Canada), paramedics use the esophageal tracheal Combitube (ETC) for prehospital airway management. OBJECTIVES Our main objective was to determine the proportion of patients with successful ventilation achieved after ETC use. Our secondary aim was to determine the number of ETC insertion attempts required to ventilate the patient. METHOD This is a retrospective cohort study. All patients who had ≥1 attempt to insert an ETC during prehospital care between January 1, 2017 and December 31, 2018 were included. Prehospital and in-hospital data were extracted. Successful ventilation was defined as thorax elevation, lung sounds on chest auscultation, or positive end-tidal capnography after ETC insertion. RESULTS A total of 580 emergency medical services interventions (99.3% cardiac arrests) were included. Most patients were men (62.5%) with a mean age 67.0 years (SD 17.6 years), and 35 (13.1%) of the 298 patients transported to emergency department survived to hospital discharge. Sufficient information to determine whether ventilation was successful or not was available for 515 interventions. Ventilation was achieved during 427 (82.7%) of these interventions. The number of ETC insertion attempts was available for 349 of the 427 successful ETC use. Overall, the first insertion resulted in successful ventilation during 294 interventions for an overall proportion of first-pass success ranging between 57.1% and 72.1%. CONCLUSION Proportions of successful ventilation and ETC first-pass success are lower than those reported in the literature with supraglottic airway devices. The reasons explaining these lower rates and their impact on patient-centered outcomes need to be studied.
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Affiliation(s)
| | | | | | - Marcel Emond
- Centre de recherche du CHU de Québec, Université Laval; VITAM - Centre de recherche en santé durable de l'Université Laval; Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval; Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | - Jessica Harrisson
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | - Sébastien Robert
- Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval
| | - Nicolas Capolla-Daneau
- Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
| | | | | | - Eric Mercier
- Centre de recherche du CHU de Québec, Université Laval; VITAM - Centre de recherche en santé durable de l'Université Laval; Département de médecine d'urgence, Institut de Cardiologie et de Pneumologie de l'Université Laval; Direction des services préhospitaliers d'urgence, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale
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Turley E, Tretiak M, Tanguay K. Effect of glycosaminoglycans and enzymes on the integrity of human placental amnion as a barrier to cell invasion. J Natl Cancer Inst 1987; 78:787-95. [PMID: 3471991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The effects of glycosaminoglycans and several enzymes on the integrity of the human placental amnion and the consequent effects on the permeability of this structure to virally transformed cells and their parent line were examined. Treatment of the amnion with hyaluronate, heparin, and chondroitin ABC lyase affected the structure of both the epithelium and the extracellular matrix and resulted in a significant increase in tumor cell invasion, but it had no significant effect on the invasion of the parent cell line. These polymers promoted the disorganization of the epithelial cell layer, and their presence resulted both in the matting of collagen fibrils in the stroma and in the loosening of the basement membrane. Pronase treatment removed epithelial cells and stripped collagen fibrils of granules, but it did not promote tumor or parent cell invasion, perhaps as a result of loss of attachment factors. Chondroitin sulfate did not affect the epithelial structure or the rate of tumor invasion and had only slight effects on the structure of the basement membrane and the stroma. These results are consistent with the thesis that the continuity of epithelium is critical to resisting tumor cell invasion and suggest that glycosaminoglycans, in addition to certain enzymes, can alter this integrity.
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