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Arends R, Austin-Ketch T, Covelli AF, Davis L, Hallas D, Kalmakis K, Kirkland-Kyhn H, Melillo KD, O'Reilly-Jacob M, Parish A, Rawlett K, Ricciardi R, Tracy C, Winkelman C, Whitehouse C. American Association of Nurse Practitioners Research Agenda, 2023-2028. J Am Assoc Nurse Pract 2024; 36:257-261. [PMID: 38564657 DOI: 10.1097/jxx.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024]
Abstract
ABSTRACT This report highlights the 2023-2028 American Association of Nurse Practitioners Research Agenda (AANP-RA), which focuses on the research goals of AANP as an organization and is based on its mission and strategic plan. The purpose of the AANP Research Agenda is to outline research priorities that advance the AANP Strategic Plan and concurrently address gaps in nursing science. American Association of Nurse Practitioners supports research studies that are rigorously designed and conducted using quantitative, qualitative, and mixed-methods approaches, as well as implementation science with the potential to positively impact both NP practice and patient health outcomes. The AANP-RA strategy is guided by the PEARL acronym: examining NP Practice, Education, policy Advocacy, Research, and Leadership. A discussion of each area is presented along with suggested topics.
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Affiliation(s)
- Robin Arends
- South Dakota State University, Brookings, South Dakota
| | | | | | - Leslie Davis
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Karen Kalmakis
- University of Massachusetts Amherst, Amherst, Massachusetts
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Coats T, Conroy S, de Groot B, Heeren P, Lim S, Lucke J, Mooijaart S, Nickel CH, Penfold R, Singler K, van Oppen JD, Polyzogopoulou E, Kruis A, McNamara R, de Groot B, Castejon-Hernandez S, Miro O, Karamercan MA, Dündar ZD, van Oppen JD, Pavletić M, Libicherová P, Balen F, Benhamed A, Dubucs X, Hernu R, Laribi S, Singler K, Fraidakis O, Fyntanidou VP, Polyzogopoulou E, Gaal S, Jónsdóttir AB, Kelly-Friel ME, McAteer CA, Sibthorpe LD, Synnott A, Zazzara MB, Coffeng SM, de Groot B, Lucke JA, Smits RAL, Castejon-Hernandez S, Llauger L, Mir SA, Ortiz MS, Padilla EE, Rodeles SC, Rojewski-Rojas W, Fadini D, Jegerlehner NS, Nickel CH, Rezzonico S, Zucconi EC, Cakmak S, Demir HA, Dündar ZD, Güven R, Karamercan MA, Sogut O, Tayfur I, Adams JA, Bernardo J, Brown L, Burton J, Butler MJ, Claassen RI, Compton F, Cooper JG, Heyes R, Ko S, Lightbody CJ, Masoli JAH, McKenzie STG, Mawhinney D, Moultrie NJ, Price A, Raman R, Rothwell LH, Shashikala RP, Smith EJ, Sorice V, van Oppen JD, Wallace JM, Young T, Benvin A, Breški E, Ćefo A, Dumić D, Ferenac R, Jurica I, Otočan M, Zinaić PŠ, Clement B, Jacquin L, Royer B, Apfelbacher SI, Bezati S, Gkarmiri S, Kaltsidou CV, Klonos G, Korka Z, Koufogianni A, Mavros V, Nano A, Ntousopoulos A, Papadopoulos N, Sason R, Zagalioti SC, Hjaltadottir I, Sigurþórsdóttir I, Skuladottir SS, Thorsteinsdottir T, Breslin D, Byrne CP, Dolan A, Harte O, Kazi D, McCarthy A, McMillan SS, Moiloa DN, O’Shaughnessy ÍL, Ramiah V, Williams S, Giani T, Levati E, Montenero R, Russo A, Salini S, van den Berg B, Booijen AM, Sir O, Vermeulen AE, ter Voert MA, Alvarez-Galarraga AC, Azeli Y, Gómez RGG, González González R, Lizardo D, Pérez ML, Madan CN, Medina JÁ, Moreno JS, Patiño EVB, Posada DMC, Rodrigo IC, Vitucci CF, Ballinari M, Dreher T, Gianinazzi L, Espejo T, Hautz WE, Rezzonico S, Bayramoğlu B, Cakmak S, Comruk B, Dogan T, Köse F, Allen TP, Ardley R, Beith CM, Boath KA, Britton HL, Campbell MMF, Capel J, Catney C, Clements S, Collins BP, Compton F, Cook A, Cosgriff EJ, Coventry T, Doyle N, Evans Z, Fasina TA, Ferrick JF, Fleming GM, Gallagher C, Golden M, Gorania D, Glass L, Greenlees H, Haddock ZP, Harris R, Hollas C, Hunter A, Ingham C, Ip SSY, James JA, Kenenden C, Jenkinson GE, Lee E, Lovick SA, McFadden M, McGovern R, Medhora J, Merchant F, Mishra S, Moreland GB, Narayanasamy S, Neal AR, Nicholls EL, Omar MT, Osborne N, Oteme FO, Pearson J, Price R, Sajan M, Sandhu LK, Scott-Murfitt H, Sealey B, Sharp EP, Spowage-Delaney BAC, Stephen F, Stevenson L, Tyrrell I, Ukoh CK, Walsh R, Watson AM, Whiteford JEC, Allston-Reeve C, Barson TJ, Giorgi MG, Godhania YL, Inchley V, Mirkes E, Rahman S. Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study. Eur Geriatr Med 2024; 15:463-470. [PMID: 38340282 PMCID: PMC10997678 DOI: 10.1007/s41999-023-00926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/19/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Current emergency care systems are not optimized to respond to multiple and complex problems associated with frailty. Services may require reconfiguration to effectively deliver comprehensive frailty care, yet its prevalence and variation are poorly understood. This study primarily determined the prevalence of frailty among older people attending emergency care. METHODS This cross-sectional study used a flash mob approach to collect observational European emergency care data over a 24-h period (04 July 2023). Sites were identified through the European Task Force for Geriatric Emergency Medicine collaboration and social media. Data were collected for all individuals aged 65 + who attended emergency care, and for all adults aged 18 + at a subset of sites. Variables included demographics, Clinical Frailty Scale (CFS), vital signs, and disposition. European and national frailty prevalence was determined with proportions with each CFS level and with dichotomized CFS 5 + (mild or more severe frailty). RESULTS Sixty-two sites in fourteen European countries recruited five thousand seven hundred eighty-five individuals. 40% of 3479 older people had at least mild frailty, with countries ranging from 26 to 51%. They had median age 77 (IQR, 13) years and 53% were female. Across 22 sites observing all adult attenders, older people living with frailty comprised 14%. CONCLUSION 40% of older people using European emergency care had CFS 5 + . Frailty prevalence varied widely among European care systems. These differences likely reflected entrance selection and provide windows of opportunity for system configuration and workforce planning.
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Moloney E, O’Donovan MR, Carpenter CR, Salvi F, Dent E, Mooijaart S, Hoogendijk EO, Woo J, Morley J, Hubbard RE, Cesari M, Ahern E, Romero-Ortuno R, Mcnamara R, O’Keefe A, Healy A, Heeren P, Mcloughlin D, Deasy C, Martin L, Brousseau AA, Sezgin D, Bernard P, Mcloughlin K, Sri-On J, Melady D, Edge L, O’Shaughnessy I, Van Damme J, Cardona M, Kirby J, Southerland L, Costa A, Sinclair D, Maxwell C, Doyle M, Lewis E, Corcoran G, Eagles D, Dockery F, Conroy S, Timmons S, O’Caoimh R. Core requirements of frailty screening in the emergency department: an international Delphi consensus study. Age Ageing 2024; 53:afae013. [PMID: 38369629 PMCID: PMC10874925 DOI: 10.1093/ageing/afae013] [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: 01/17/2023] [Revised: 10/24/2023] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Frailty is associated with adverse outcomes among patients attending emergency departments (EDs). While multiple frailty screens are available, little is known about which variables are important to incorporate and how best to facilitate accurate, yet prompt ED screening. To understand the core requirements of frailty screening in ED, we conducted an international, modified, electronic two-round Delphi consensus study. METHODS A two-round electronic Delphi involving 37 participants from 10 countries was undertaken. Statements were generated from a prior systematic review examining frailty screening instruments in ED (logistic, psychometric and clinimetric properties). Reflexive thematic analysis generated a list of 56 statements for Round 1 (August-September 2021). Four main themes identified were: (i) principles of frailty screening, (ii) practicalities and logistics, (iii) frailty domains and (iv) frailty risk factors. RESULTS In Round 1, 13/56 statements (23%) were accepted. Following feedback, 22 new statements were created and 35 were re-circulated in Round 2 (October 2021). Of these, 19 (54%) were finally accepted. It was agreed that ideal frailty screens should be short (<5 min), multidimensional and well-calibrated across the spectrum of frailty, reflecting baseline status 2-4 weeks before presentation. Screening should ideally be routine, prompt (<4 h after arrival) and completed at first contact in ED. Functional ability, mobility, cognition, medication use and social factors were identified as the most important variables to include. CONCLUSIONS Although a clear consensus was reached on important requirements of frailty screening in ED, and variables to include in an ideal screen, more research is required to operationalise screening in clinical practice.
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Affiliation(s)
- Elizabeth Moloney
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland
| | - Mark R O’Donovan
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland
| | - Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO 63110-1010, USA
| | - Fabio Salvi
- Department of Geriatrics and Emergency Care, INRCA-IRCCS, Ancona 5-60124, Italy
| | - Elsa Dent
- The Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia 5000, Australia
| | - Simon Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden 2300, Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Centre, Amsterdam 1081, Netherlands
| | - Jean Woo
- Department of Medicine, Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - John Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Ruth E Hubbard
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Matteo Cesari
- IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan 20122, Italy
| | - Emer Ahern
- Department of Geriatric Medicine, Cork University Hospital, Cork, T12 DC4A, Ireland
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin, D08 NHY1, Ireland
- Mercers Institute for Successful Ageing, St James's Hospital, Dublin 8, D08 E9P6, Ireland
| | - Rosa Mcnamara
- Emergency Department, St Vincent's University Hospital, Dublin 4, D04 T6F4, Ireland
| | - Anne O’Keefe
- Emergency Department, Mercy University Hospital, Cork, T12WE28, Ireland
| | - Ann Healy
- Emergency Department, Mercy University Hospital, Cork, T12WE28, Ireland
| | - Pieter Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven 3000, Belgium
| | - Darren Mcloughlin
- Emergency Department, Mercy University Hospital, Cork, T12WE28, Ireland
| | - Conor Deasy
- Emergency Department, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Louise Martin
- Emergency Department, Cork University Hospital, Wilton, Cork, T12 DC4A, Ireland
| | - Audrey Anne Brousseau
- Département de médecine familiale et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, J1K 2R1, Canada
| | - Duygu Sezgin
- School of Nursing and Midwifery, University of Galway, Galway City, H91 TK33, Ireland
| | - Paul Bernard
- Beaumont Hospital, Occupational Therapy, Dublin, D09V2N0, Ireland
| | - Kara Mcloughlin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Jiraporn Sri-On
- Geriatric Emergency Medicine Unit, Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Don Melady
- Department of Family and Community Medicine, Schwarz/Reisman Emergency Medicine Institute, Mount Sinai Health System, University of Toronto, Toronto, Ontario, ON M5G 1E2, Canada
| | - Lucinda Edge
- Department of Physiotherapy, St James’s Hospital, Dublin 8, Dublin, Ireland
| | - Ide O’Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario N2L 3G1, Canada
| | - Magnolia Cardona
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane 4067, Australia
| | - Jennifer Kirby
- Urgent Care Team, University Hospital North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - Lauren Southerland
- Department of Emergency Medicine, The Ohio State University, Wexner Medical Centre, Columbus, Ohio 43210, USA
| | - Andrew Costa
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Douglas Sinclair
- Department of Medicine, Quality, and Safety, IWK Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Cathy Maxwell
- Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA
| | - Marie Doyle
- Emergency Department, University Hospital Waterford, Waterford, X91 ER8E, Ireland
| | - Ebony Lewis
- UNSW School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, NSW 2052, Australia
| | - Grace Corcoran
- Department of Physiotherapy, Beaumont Hospital, Dublin, D09V2N0, Ireland
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada
| | - Frances Dockery
- Department of Geriatric Medicine, Beaumont Hospital, Dublin, D09V2N0, Ireland
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, WC1E 6BT, UK
| | - Suzanne Timmons
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12 YN60, Ireland
| | - Rónán O’Caoimh
- HRB Clinical Research Facility, Mercy University Hospital, University College Cork, Cork City, T12 WE28, Ireland
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, T12 YN60, Ireland
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
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Moloney E, O'Donovan MR, Sezgin D, McGrath K, Timmons S, O'Caoimh R. Frailty Knowledge, Use of Screening Tools, and Educational Challenges in Emergency Departments in Ireland: A Multisite Survey. J Emerg Nurs 2024; 50:22-35. [PMID: 37804277 DOI: 10.1016/j.jen.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Recognizing frailty and providing evidenced-based management in busy emergency departments is challenging. Understanding the knowledge and educational needs of ED staff is important to design training that might improve patient outcomes. OBJECTIVE This study aimed to explore frailty knowledge of ED staff, use of frailty screening instruments in Irish emergency departments, and educational challenges in the emergency department. METHODS A multisite survey of ED staff (different specialties) was conducted between April and September 2021. An anonymous online survey was distributed via email. Free-text sections were analyzed using content analysis. RESULTS In total, 168 staff (nursing, medical and allied health) participated, representing 9 of 26 Irish emergency departments (35%). Most respondents were nurses (n = 78, 46%). Less than half of respondents had received frailty identification training (n = 81, 48%). One-fifth of emergency doctors and nurses (20%) were unsure how to define frailty. Major barriers to ED frailty screening were resource deficits, insufficient diagnostic pathways from the emergency departments, and lack of education on suitable instruments. CONCLUSIONS Most of the ED staff surveyed relied on clinical judgment rather than formal training in frailty identification. A high proportion reported poor knowledge and low confidence in recognizing frailty. Dedicated staff with frailty management expertise, bespoke education initiatives, and clearly defined frailty screening pathways may help address the issues identified.
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Street A, Maynou L, Conroy S. Did the Acute Frailty Network improve outcomes for older people living with frailty? A staggered difference-in-difference panel event study. BMJ Qual Saf 2023; 32:721-731. [PMID: 37414555 DOI: 10.1136/bmjqs-2022-015832] [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: 12/13/2022] [Accepted: 05/24/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES To evaluate whether the Acute Frailty Network (AFN) was more effective than usual practice in supporting older people living with frailty to return home from hospital sooner and healthier. DESIGN Staggered difference-in-difference panel event study allowing for differential effects across intervention cohorts. SETTING All English National Health Service (NHS) acute hospital sites. PARTICIPANTS All 1 410 427 NHS patients aged 75+ with high frailty risk who had an emergency hospital admission to acute, general or geriatric medicine departments between 1 January 2012 and 31 March 2019. INTERVENTION Membership of the AFN, a quality improvement collaborative designed to support acute hospitals in England deliver evidence-based care for older people with frailty. 66 hospital sites joined the AFN in six sequential cohorts, the first starting in January 2015, the sixth in May 2018. Usual care was delivered in the remaining 248 control sites. MAIN OUTCOME MEASURES Length of hospital stay, in-hospital mortality, institutionalisation, hospital readmission. RESULTS No significant effects of AFN membership were found for any of the four outcomes nor were there significant effects for any individual cohort. CONCLUSIONS To realise its aims, the AFN might need to develop better resourced intervention and implementation strategies.
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Affiliation(s)
- Andrew Street
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Laia Maynou
- Department of Health Policy, The London School of Economics and Political Science, London, UK
- Deparment of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Barcelona, Spain
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
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Conneely M, Leahy S, O’Connor M, Corey G, Gabr A, Saleh A, Okpaje B, O’ Shaughnessy Í, Synnott A, McCarthy A, Holmes A, Robinson K, Ryan L, Griffin A, Barry L, Trépel D, Ryan D, Galvin R. A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS). Clin Interv Aging 2023; 18:1769-1788. [PMID: 37901478 PMCID: PMC10612516 DOI: 10.2147/cia.s413961] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS). Patients and Methods Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient's home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive. Results Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group. Conclusion ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group. Trial Registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.
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Affiliation(s)
- Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Leahy
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Gillian Corey
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Ahmed Gabr
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Anastasia Saleh
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Blessing Okpaje
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Íde O’ Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife Synnott
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife McCarthy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Alison Holmes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lorna Ryan
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Barry
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dominic Trépel
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Damian Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - On behalf of Ageing Research Centre Public and Patient Involvement (PPI) Panel of older adults
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
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Corcoran G, Bernard P, Kenna L, Malone A, Horgan F, O'Brien C, Ward P, Howard W, Hogan L, Mooney R, Masterson S. "Older People Want to Be in Their Own Homes": A Service Evaluation of Patient and Carer Feedback after Pathfinder Responded to Their Emergency Calls. PREHOSP EMERG CARE 2023; 27:866-874. [PMID: 36633524 DOI: 10.1080/10903127.2023.2168094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Older people experience high rates of adverse outcomes following emergency department (ED) presentation. There is growing evidence to support alternative care pathways for certain types of emergency medical services (EMS) calls. Pathfinder is one such service and targets patients aged 65 years and over, whose presenting issues can be safely managed at home by immediate paramedic, occupational therapy, and/or physiotherapy interventions. The aim of this service evaluation was to understand how older people feel about being treated at home as a result of EMS calls and to understand their experiences of the Pathfinder service. METHODS This was a thematic analysis of open-ended responses recorded from telephone interviews during routine service evaluation with service users (patients or their next-of-kin). RESULTS Of 573 service users, telephone interviews were conducted with 429 (75%). Five primary themes were identified: (1) professionalism of the multidisciplinary clinical team; (2) "the right service, in the right place, at the right time"; (3) role of Pathfinder in "getting the ball rolling"; (4) lasting effects of the experience on the patient and his or her next-of-kin; (5) value of skilled communication with the older person. CONCLUSION Older people and their next-of-kin voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be treated in their homes at the time of an EMS call rather than default conveyance to the ED. They appreciated the importance of a skilled multidisciplinary team with a follow-up service that effectively positions itself between the acute hospital and community services.
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Affiliation(s)
- Grace Corcoran
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Paul Bernard
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Lawrence Kenna
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Ailish Malone
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire O'Brien
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Peter Ward
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Willie Howard
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Laura Hogan
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Rebecca Mooney
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Benhamed A, Batomen B, Boucher V, Yadav K, Mercier É, Isaac CJ, Bérubé M, Bernard F, Chauny JM, Moore L, Sirois MJ, Tazarourte K, Gossiome A, Émond M. Epidemiology, injury pattern and outcome of older trauma patients: A 15-year study of level-I trauma centers. PLoS One 2023; 18:e0280345. [PMID: 36716316 PMCID: PMC9886263 DOI: 10.1371/journal.pone.0280345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/26/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Older adults have become a significant portion of the trauma population. Exploring their specificities is crucial to better meet their specific needs. The primary objective was to evaluate the temporal changes in the incidence, demographic and trauma characteristics, injury pattern, in-hospital admission, complications, and outcome of older trauma patients. METHODS A multicenter retrospective cohort study was conducted using the Quebec Trauma Registry. Patients aged ≥16 years admitted to one of the three adult level-I trauma centers between 2003 and 2017 were included. Descriptive analyses and trend-tests were performed to describe temporal changes. RESULTS A total of 53,324 patients were included, and 24,822 were aged ≥65 years. The median [IQR] age increased from 57[36-77] to 67[46-82] years, and the proportion of older adults rose from 41.8% in 2003 to 54.1% in 2017. Among those, falls remain the main mechanism (84.7%-88.3%), and the proportion of severe thorax (+8.9%), head (+8.7%), and spine (+5%) injuries significantly increased over time. The proportion of severely injured older patients almost doubled (17.6%-32.3%), yet their mortality decreased (-1.0%). Their average annual bed-days consumption also increased (+15,004 and +1,437 in non-intensive care wards and ICU, respectively). CONCLUSIONS Since 2014, older adults have represented the majority of admissions in Level-I trauma centers in Québec. Their bed-days consumption has greatly increased, and their injury pattern and severity have deeply evolved, while we showed a decrease in mortality.
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Affiliation(s)
- Axel Benhamed
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, QC, Canada
- Hospices Civils de Lyon, Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, France
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Brice Batomen
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Dalla Lana school of public health, University of Toronto, Toronto, Ontario, Canada
| | - Valérie Boucher
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Éric Mercier
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Mélanie Bérubé
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Francis Bernard
- Section of Critical Care, Department of Medicine, University of Montreal, Montreal, Canada
| | - Jean- Marc Chauny
- Department of Emergency Medicine, Research Center, CIUSSS-Nord-de-l’Île de-Montréal, Hôpital Sacré-Cœur de Montréal, Montréal, QC, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, QC, Canada
| | - Marie Josée Sirois
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Karim Tazarourte
- Hospices Civils de Lyon, Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, France
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Amaury Gossiome
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Hospices Civils de Lyon, Service d’Accueil des Urgences–SAMU 69, Centre Hospitalier Universitaire Édouard Herriot, Lyon, France
| | - Marcel Émond
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine d’urgence, CHU de Québec-Université Laval, Québec, QC, Canada
- * E-mail:
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Lee AD, deGraauw L, Muir BJ, Belchos M, Oh D, Szabo K, Murnaghan K, deGraauw C, Howitt S. Identifying and prioritizing research to inform a research agenda for Canadian chiropractors working in sport - the Canadian sports chiropractic perspective. J Can Chiropr Assoc 2022; 66:227-243. [PMID: 36818363 PMCID: PMC9914826] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Objectives To identify and prioritize research to inform research agenda development for Canadian chiropractors working in sport. Methods Clinicians, researchers and leaders from the Canadian sports chiropractic field were invited to participate in 1) a survey to refine a list of research priorities, 2) a Delphi procedure to determine consensus on these priorities, and 3) a prioritization survey. Results The top three research priorities were 1) effects of interventions on athletic outcomes, 2) research about sports healthcare teams, and 3) clinical research related to spinal manipulative and mobilization therapy. The three highest ranked conditions to research were 1) low back pain, 2) neck pain, and 3) concussion. Collaborations with sports physicians and universities/ colleges were rated as important research collaborations to pursue. Conclusions These results represent the Canadian sports chiropractic perspective to research priority setting and will be used alongside stakeholder input to set the first research agenda for the Canadian sports chiropractic field.
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Affiliation(s)
| | - Lara deGraauw
- Department of Clinical Education, Canadian Memorial Chiropractic College
| | - Brad J Muir
- Department of Clinical Education, Canadian Memorial Chiropractic College
| | - Melissa Belchos
- Institute for Disability and Rehabilitation Research, Ontario Tech University,Faculty of Health Sciences, Ontario Tech University
| | - David Oh
- Department of Graduate Studies, Canadian Memorial Chiropractic College
| | | | | | - Chris deGraauw
- Department of Clinical Education, Canadian Memorial Chiropractic College
| | - Scott Howitt
- Department of Clinical Education, Canadian Memorial Chiropractic College
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Barbeau VI, Madani L, Al Ameer A, Tanjong Ghogomu E, Beecher D, Conde M, Howe TE, Marcus S, Morley R, Nasser M, Smith M, Thompson Coon J, Welch VA. Research priority setting related to older adults: a scoping review to inform the Cochrane-Campbell Global Ageing Partnership work programme. BMJ Open 2022; 12:e063485. [PMID: 36123060 PMCID: PMC9486333 DOI: 10.1136/bmjopen-2022-063485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore and map the findings of prior research priority-setting initiatives related to improving the health and well-being of older adults. DESIGN Scoping review. DATA SOURCES Searched MEDLINE, EMBASE, AgeLine, CINAHL and PsycINFO databases from January 2014 to 26 April 2021, and the James Lind Alliance top 10 priorities. ELIGIBILITY CRITERIA We included primary studies reporting research priorities gathered from stakeholders that focused on ageing or the health of older adults (≥60 years). There were no restrictions by setting, but language was limited to English and French. DATA EXTRACTION AND SYNTHESIS We used a modified Reporting Guideline for Priority Setting of Health Research (REPRISE) guideline to assess the transparency of the reported methods. Population-intervention-control-outcome (PICO) priorities were categorised according to their associated International Classification of Health Interventions (ICHI) and International Classification of Functioning (ICF) outcomes. Broad research topics were categorised thematically. RESULTS Sixty-four studies met our inclusion criteria. The studies gathered opinions from various stakeholder groups, including clinicians (n=56 studies) and older adults (n=35), and caregivers (n=24), with 75% of the initiatives involving multiple groups. None of the included priority-setting initiatives reported gathering opinions from stakeholders located in low-income or middle-income countries. Of the priorities extracted, 272 were identified as broad research topics, while 217 were identified as PICO priorities. PICO priorities that involved clinical outcomes (n=165 priorities) and interventions concerning health-related behaviours (n=59) were identified most often. Broad research topics on health services and systems were identified most often (n=60). Across all these included studies, the reporting of six REPRISE elements was deemed to be critically low. CONCLUSION Future priority setting initiatives should focus on documenting a more detailed methodology with all initiatives eliciting opinions from caregivers and older adults to ensure priorities reflect the opinions of all key stakeholder groups.
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Affiliation(s)
| | - Leen Madani
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | | | | | | | - Monserrat Conde
- Cochrane Campbell Global Ageing Partnership, Portimao, Portugal
- University of Oxford Centre for Evidence-Based Medicine, Oxford, UK
| | - Tracey E Howe
- Cochrane Campbell Global Ageing Partnership, Glasgow, UK
| | - Sue Marcus
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | - Jo Thompson Coon
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
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11
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Garcia-Pérez D, Robles-Perea L, Vena-Martínez A, Arnau A, Robles-Bernabeu G, Espaulella-Panicot J. [3D/3D+ as a tool for rapid geriatric assessment and adequacy of the care resource at discharge from the Emergency Department]. Rev Esp Geriatr Gerontol 2022; 57:212-219. [PMID: 35781176 DOI: 10.1016/j.regg.2022.06.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Assess the 3D/3D+ rapid geriatric assessment tool for the early detection of frailty, its usefulness to identify the effects of the acute process on the functional, physical, cognitive and socioenvironmental dimensions, as well as the medications that may have triggered the patient's reason for visit. Finally, assess the usefulness of 3D/3D+ together with the clinical diagnosis to adequate care resource at discharge from the emergency department (ED). METHOD Retrospective observational cohort study. Patients ≥75 years old, with clinical complexity visited at the ED were included. Basal frailty status was assessed using 3D (basal component), and the multidimensional impact of the acute process using 3D+ (current component). The main dependent variable was adequacy of the care resource at ED discharge. RESULTS 278 patients were included, mean age 86 years (interquartile range: 83-90), 59.7% were women. According to the basal component (3D), 83.1% (95%CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) was altered in 60.1% (95%CI: 54.1-65.9). The adequacy of ED discharge was correct in 96.4% (95%CI: 93.0-98.0). One out of 4patients was admitted to a medicine ward. CONCLUSIONS 3D/3D+ facilitates an optimal model of emergency care adapted to patients ≥ 75 years old treated in EDs. It stratifies the level of frailty (3D), detects the severity of patients' acute problems (3D+) and contributes to decision-making regarding the most appropriate care resource at ED discharge.
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Affiliation(s)
- Dolors Garcia-Pérez
- Servicio de Urgencias y Emergencias, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España; Programa de Doctorado en Medicina y Ciencias Biomédicas, Universidad de Vic-Universidad Central de Catalunya (UVic-UCC), Vic, Barcelona, España; Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic, Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, España.
| | - Laura Robles-Perea
- Servicio de Urgencias y Emergencias, Hospital de Figueres (Fundació Salut Empordà), Figueres, Girona, España; Sistema d'Emergències Mèdiques (SEM), Catalunya, España
| | - A Vena-Martínez
- Unidad de Geriatría de Urgencias, Servicio de Geriatría, Hospital Universitari de Santa Maria de Lleida, Lleida, España
| | - Anna Arnau
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic, Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, España; Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
| | - Gerard Robles-Bernabeu
- Servicio Territorial de Geriatría y Cuidados Paliativos, Consorci Hospitalri Vic-Fundació Hospital de la Santa Creu de Vic, Vic, Barcelona, España
| | - Joan Espaulella-Panicot
- Grupo de Investigación en Cronicidad de la Cataluña Central (C3RG), Centre d'Estudis Sanitaris i Socials (CESS), Universitat de Vic, Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, España; Servicio Territorial de Geriatría y Cuidados Paliativos, Consorci Hospitalri Vic-Fundació Hospital de la Santa Creu de Vic, Vic, Barcelona, España
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12
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Conneely M, Leahy S, Dore L, Trépel D, Robinson K, Jordan F, Galvin R. The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review. BMC Geriatr 2022; 22:462. [PMID: 35643453 PMCID: PMC9145107 DOI: 10.1186/s12877-022-03007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults following presentation to the ED. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED. Methods Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and the PROSPERO register up until June 2020. Grey literature was also searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed using a matrix of evidence table. An algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied for all outcomes. Results Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate. Results were presented narratively and summary of evidence tables created. Conclusion Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The existing evidence for the effectiveness of ED interventions for older adults is limited. This umbrella review highlights the challenge of synthesising evidence due to significant heterogeneity in methods, intervention content and reporting of outcomes. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended, rather than the publication of further systematic reviews. Trial registration UMBRELLA REVIEW REGISTRATION: PROSPERO (CRD42020145315). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03007-5.
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13
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Rueegg M, Nissen SK, Brabrand M, Kaeppeli T, Dreher T, Carpenter CR, Bingisser R, Nickel CH. The clinical frailty scale predicts 1-year mortality in emergency department patients aged 65 years and older. Acad Emerg Med 2022; 29:572-580. [PMID: 35138670 PMCID: PMC9320818 DOI: 10.1111/acem.14460] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/22/2022]
Abstract
Objective To validate the Clinical Frailty Scale (CFS) for prediction of 1‐year all‐cause mortality in the emergency department (ED) and compare its performance to the Emergency Severity Index (ESI). Methods Prospective cohort study at the ED of a tertiary care center in Northwestern Switzerland. All patients aged ≥65 years were included from March 18 to May 20, 2019, after informed consent. Frailty status was assessed using CFS, excluding level 9 (palliative). Acuity level was assessed using ESI. Both CFS and ESI were adjusted for age, sex and presenting condition in multivariable logistic regression. Prognostic performance was assessed for discrimination and calibration separately. Estimates were internally validated by Bootstrapping. Restricted mean survival time (RMST) was determined for all levels of CFS. Results In the final study population of 2191 patients, 1‐year all‐cause mortality was 17% (n = 372). RMST values ranged from 219 days for CFS 8 to 365 days for CFS 1. The adjusted CFS model had an area under receiver operating characteristic of 0.767 (95% confidence interval [CI]: 0.741–0.793), compared to 0.703 (95% CI: 0.673–0.732) for the adjusted ESI model. Conclusion The CFS predicts 1‐year all‐cause mortality for older ED patients and predicts survival time in a graded manner. The CFS is superior to the ESI when adjusted for age, sex, and presenting condition.
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Affiliation(s)
- Marco Rueegg
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
| | - Søren Kabell Nissen
- Institute of Regional Health Research, Centre South‐West Jutland University of Southern Denmark Odense Denmark
| | - Mikkel Brabrand
- Institute of Regional Health Research, Centre South‐West Jutland University of Southern Denmark Odense Denmark
- Department of Emergency Medicine Odense University Hospital, University of Southern Denmark Odense Denmark
| | - Tobias Kaeppeli
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
| | - Thomas Dreher
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
| | - Christopher R. Carpenter
- Department of Emergency MedicineWashington University in St. Louis School of Medicine, Emergency Care Research CoreSt. LouisMichiganUSA
| | - Roland Bingisser
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
| | - Christian H. Nickel
- Emergency Department University Hospital Basel, University of Basel Basel Switzerland
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14
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Nickel CH, Nissen SK. Still under our radar: elder mistreatment. Eur J Emerg Med 2022; 29:97-8. [PMID: 35210376 DOI: 10.1097/MEJ.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
As the world's population continues to age over the decades ahead, medical educators and researchers in every adult medical and surgical specialty will need to 'geriatricise' their clinical science. Many have already engaged with geriatrics. Here we describe the progress that has been made and the opportunities ahead in the field of Geriatric Emergency Medicine (GEM), a field that has taken large steps in integrating holistic care. Future opportunities exist in the three domains of evidence-based medicine: including patient preferences and needs, generating scientific evidence, and improving physician knowledge and expertise. Implementation requires new innovations also in the organisation of care. Similar strategies may be useful in other fields of medicine, in making holistic care the standard for older people.
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Affiliation(s)
- Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Christopher R Carpenter
- Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Simon P Conroy
- UCL MRC Unit for Lifelong Health and Ageing at UCL 5th Floor, 1-19 Torrington Place, London, WC1E7HB, UK
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Conneely M, Leahy A, O'Connor M, Barry L, Corey G, Griffin A, O'Shaughnessy Í, O'Carroll I, Leahy S, Trépel D, Ryan D, Robinson K, Galvin R. A physiotherapy-led transition to home intervention for older adults following emergency department discharge: protocol for a pilot feasibility randomised controlled trial. Pilot Feasibility Stud 2022; 8:3. [PMID: 34980285 PMCID: PMC8720939 DOI: 10.1186/s40814-021-00954-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Older adults frequently attend the emergency department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. This paper reports a protocol designed to evaluate the feasibility of conducting a three arm randomised controlled trial (RCT) within the ED setting and in the patient’s home. The interventions are comprehensive geriatric assessment (CGA), ED PLUS and usual care. Methods The ED PLUS pilot trial is designed as a feasibility RCT conducted in the ED and Acute Medical Assessment Unit of a university teaching hospital in the mid-west region of Ireland. We aim to recruit 30 patients, aged 65 years and over presenting to the ED with undifferentiated medical complaints and discharged within 72 h of index visit. Patients will be randomised by a computer in a ratio of 1:1:1 to deliver usual care, CGA or ED PLUS during a 6-month study period. A randomised algorithm is used to perform randomization. CGA will include a medical assessment, medication review, nursing assessment, falls assessment, assessment of mobility and stairs, transfers, personal care, activities of daily living (ADLs), social supports and baseline cognition. ED PLUS, a physiotherapist led, multidisciplinary intervention, aims to bridge the transition of care between the index visit to the ED and the community by initiating a CGA intervention in the ED and implementing a 6-week follow-up self-management programme in the patient’s own home following discharge from the ED. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Discussion Rising ED visits and an ageing population with chronic health issues render ED interventions to reduce adverse outcomes in older adults a research priority. This feasibility RCT will generate data and experience to inform the conduct and delivery of a definite RCT. Trial registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT049836020. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00954-5.
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Affiliation(s)
- Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Aoife Leahy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Louise Barry
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Gillian Corey
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Íde O'Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Ida O'Carroll
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Siobhán Leahy
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Galway-Mayo Institute of Technology, Dublin Road, Galway, Ireland
| | - Dominic Trépel
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Damian Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Vloet LCM, Hesselink G, Berben SAA, Hoogeveen M, Rood PJT, Ebben RHA. The updated national research agenda 2021-2026 for prehospital emergency medical services in the Netherlands: a Delphi study. Scand J Trauma Resusc Emerg Med 2021; 29:162. [PMID: 34801072 PMCID: PMC8605575 DOI: 10.1186/s13049-021-00971-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/23/2021] [Indexed: 12/01/2022] Open
Abstract
Background In 2015, a national research agenda was established for Dutch prehospital EMS to underpin the evidence base of care delivery and inform policymakers and funders. The continuously increasing demand for ambulance care and the reorientation towards the role of EMS in recent years may have changed research priorities. Therefore, this study aimed to update the Dutch national EMS research agenda. Methods A three-round online Delphi survey was used to explore and discuss different viewpoints and to reach consensus on research priorities (i.e., themes and special interest groups, e.g. patient types who require specific research attention). A multidisciplinary expert panel (n = 62) was recruited in the field of prehospital EMS and delegates of relevant professional organizations and stakeholders participated. In round one, fifty-nine research themes and six special interest groups (derived from several resources) were rated on importance on a 5-point scale by the panel members. In round two, the panel selected their priority themes and special interest groups (yes/no), and those with a positive difference score were further assessed in round three. In this final round, appropriateness of the remaining themes and agreement within the panel was taken into account, following the RAND/UCLA appropriateness method, which resulted in the final list of research priorities. Results The survey response per round varied between 94 and 100 percent. In round one, a reduction from 59 to 25 themes and the selection of three special interest groups was realized. Round two resulted in the prioritization of six themes and one special interest group ('Vulnerable elderly'). Round three showed an adequate level of agreement regarding all six themes: 'Registration and (digital) exchange of patient data in the chain of emergency care'; 'Mobile care consultation/Non conveyance'; 'Care coordination'; 'Cooperation with professional partners within the care domain'; 'Care differentiation' and 'Triage and urgency classification'. Conclusions The updated Dutch national EMS research agenda builds further on the previous version and introduces new EMS research priorities that correspond with the future challenges prehospital EMS care is faced with. This agenda will guide researchers, policymakers and funding bodies in prioritizing future research projects. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00971-6.
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Affiliation(s)
- Lilian C M Vloet
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gijs Hesselink
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sivera A A Berben
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Margreet Hoogeveen
- Dutch National Sector Organization for Ambulance Care (Ambulancezorg Nederland, AZN), PO BOX 4898000 AL, Zwolle, The Netherlands
| | - Paul J T Rood
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands
| | - Remco H A Ebben
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands.
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18
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Lucke JA, Mooijaart SP, Heeren P, Singler K, McNamara R, Gilbert T, Nickel CH, Castejon S, Mitchell A, Mezera V, Van der Linden L, Lim SE, Thaur A, Karamercan MA, Blomaard LC, Dundar ZD, Chueng KY, Islam F, de Groot B, Conroy S. Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine. Eur Geriatr Med 2021; 13:309-317. [PMID: 34738224 PMCID: PMC8568564 DOI: 10.1007/s41999-021-00578-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023]
Abstract
Aim The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Findings Eight posters with expert clinical guidelines on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/. Message Expert clinical recommendations for Geriatric Emergency Medicine in Europe were created and are ready for dissemination across Europe. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00578-1. Purpose Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Methods A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. Results Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/. Conclusion Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00578-1.
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Affiliation(s)
- J A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands.
| | - S P Mooijaart
- Department of Internal Medicine, Section on Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - P Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - K Singler
- Department of Geriatrics, Klinikum Nürnberg, Paracelsus Private, Medical University, Nuremberg, Germany.,Institute for Biomedicine of Ageing, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany
| | - R McNamara
- Department of Emergency Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - T Gilbert
- Department of Geriatric Medicine, Lyon-Sud University Hospital, Lyon, France
| | - C H Nickel
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - S Castejon
- Department of Geriatrics and Palliative Care, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - A Mitchell
- Department of Emergency Medicine, Sligo University Hospital, Sligo, Ireland
| | - V Mezera
- Geriatric Center, Pardubice Hospital, Pardubice, Czech Republic
| | - L Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - S E Lim
- Academic Geriatric Medicine, University of Southampton, Southampton, UK
| | - A Thaur
- Department of Emergency Medicine, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - M A Karamercan
- Department of Emergency Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - L C Blomaard
- Department of Internal Medicine, Section on Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Z D Dundar
- Department of Emergency Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - K Y Chueng
- Accident and Emergency Department, United Christian Hospital, Kwun Tong, Hong Kong
| | - F Islam
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - B de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - S Conroy
- Geriatric Medicine, MRC Unit for Lifelong Health and Ageing at UCL, 5th Floor, 1-19 Torrington Place, London, WC1E 7HB, UK
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19
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Bernard P, Corcoran G, Kenna L, O’Brien C, Ward P, Howard W, Hogan L, Mooney R, Masterson S. Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis. Age Ageing 2021; 50:1854-1858. [PMID: 34107008 DOI: 10.1093/ageing/afab095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND many patients brought to emergency departments (EDs) following an emergency medical services (EMS) call have non-urgent needs that could be treated elsewhere. Older people are particularly vulnerable to adverse events while attending the ED. Alternative care pathway models can reduce ED crowding and improve outcomes. Internationally, there is no consensus on which model is recommended. AIM the aim of this study is to investigate the impact of the Pathfinder model on ED conveyance rates and patient safety. METHODS the Pathfinder service is a collaboration between the National Ambulance Service and Beaumont Hospital Occupational Therapy and Physiotherapy Departments. It is supported by the Government of Ireland's Sláintecare Integration fund. This is a retrospective cohort study of the Pathfinder service over a 5-month period. RESULTS one-hundred and seventy-eight patients were responded to by the Pathfinder 'Rapid Response Team'. Average age was 79.6 years (standard deviation 7.6), median clinical frailty score was 6 (interquartile range: 5-6). Sixty-four percent remained at home following initial review. None re-presented to the ED within 24 hours, and 10% re-presented within 7 days. The majority (67%) of patients required follow-up by the Pathfinder 'Follow-Up Team' and/or another community-based service. Feedback demonstrates 99% patient satisfaction with the service. CONCLUSION the Pathfinder service is a safe alternative to ED conveyance for older people following an EMS call. It is the first model of this kind to be evaluated in Ireland. The overwhelmingly positive feedback confirms that older people want this service. This model could expand, with local adaptation, nationally and internationally.
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Affiliation(s)
- Paul Bernard
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Grace Corcoran
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Lawrence Kenna
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Claire O’Brien
- Occupational Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Peter Ward
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - William Howard
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Laura Hogan
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Rebecca Mooney
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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20
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Beil M, Flaatten H, Guidet B, Sviri S, Jung C, de Lange D, Leaver S, Fjølner J, Szczeklik W, van Heerden PV. The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care? Crit Care 2021; 25:330. [PMID: 34507597 PMCID: PMC8431262 DOI: 10.1186/s13054-021-03750-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
There is ongoing demographic ageing and increasing longevity of the population, with previously devastating and often-fatal diseases now transformed into chronic conditions. This is turning multi-morbidity into a major challenge in the world of critical care. After many years of research and innovation, mainly in geriatric care, the concept of multi-morbidity now requires fine-tuning to support decision-making for patients along their whole trajectory in healthcare, including in the intensive care unit (ICU). This article will discuss current challenges and present approaches to adapt critical care services to the needs of these patients.
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Affiliation(s)
- Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care Medicine, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Service de Reanimation, Hopital Saint-Antoine, Paris, France
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center, University of Utrecht, Utrecht, The Netherlands
| | - Susannah Leaver
- Department of Adult Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hadassah University Hospital, Hebrew University of Jerusalem, Jerusalem, Israel.
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21
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Chong E, Bao M, Goh EF, Lim WS. SARC-F at the Emergency Department: Diagnostic Performance for Frailty and Predictive Performance for Reattendances and Acute Hospitalizations. J Nutr Health Aging 2021; 25:1084-1089. [PMID: 34725665 DOI: 10.1007/s12603-021-1676-5] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Sarcopenia is associated with adverse health outcomes including mortality, functional loss, falls, and poorer quality of life. However, the value of screening sarcopenia at the Emergency Department (ED) remains unclear. We aimed to examine the SARC-F questionnaire for its (1) diagnostic ability in identifying frailty, and (2) predictive ability for adverse health outcomes. DESIGN A secondary analysis of a quasi-experimental study. SETTING An ED within a 1700-bed tertiary hospital. PARTICIPANTS ED patients aged ≥85 years (mean age 90.0 years) recruited into the Emergency Department Interventions of Frailty (EDIFY) study. MEASUREMENTS Data of demographics, premorbid function, frailty status [Frailty Index (FI), Clinical Frailty Scale (CFS), FRAIL], comorbidities, medications, and cognitive status were gathered. We also captured outcomes of mortality, acute hospitalization, and ED reattendance at 1-, 3-, and 6-month. We then compared area under the operating characteristic curves (AUCs) for the abovementioned measures against the FI (reference) for diagnosis of frailty. Lastly, we performed univariate analyses and logistic regression to compare SARC-F and other measures against the adverse outcomes of interest. RESULTS Amongst the various instruments, the SARC-F (AUC 0.92, 95% Confidence Interval (CI) 0.86-0.98, P<0.001; Sensitivity 79.0%, and Specificity 88.9%) performed best for frailty detection as defined by FI. Optimal cutoff was ≥3 (Sensitivity 91.4%, Specificity 83.3%, and Negative Predictive Value 68.2%). Only SARC-F was predictive of acute hospitalization [Adjusted Odds Ratio (OR) 4.00, 95% CI 1.47-10.94, P=0.007] and ED-reattendance [Adjusted OR 3.29, 95% CI 1.26-8.56, P=0.015] at 3-month. CONCLUSIONS The SARC-F demonstrated excellent diagnostic ability for frailty detection and predictive validity for ED reattendance and acute hospitalization at 3 months. Lowering cutoff score to ≥3 may improve case-finding at the ED to facilitate early identification and management of sarcopenia. Further studies are required to validate the diagnostic and predictive performance of SARC-F at ED settings.
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Affiliation(s)
- E Chong
- Edward Chong, Department of Geriatric Medicine and Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Contact number: (65) 63596330/1, Fax number: (65) 63596294,
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22
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Cagnazzo F, Arquizan C, Derraz I, Dargazanli C, Lefevre PH, Riquelme C, Gaillard N, Mourand I, Gascou G, Bonafe A, Costalat V. Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature. J Neurol 2020; 268:2656-2665. [PMID: 33125542 PMCID: PMC7597753 DOI: 10.1007/s00415-020-10285-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
Objective To perform an updated review of the literature on the neurological manifestations of COVID-19-infected patients Methods A PRISMA-guideline-based systematic review was conducted on PubMed, EMBASE, and SCOPUS. Series reporting neurological manifestations of COVID-19 patients were studied. Results 39 studies and 68,361 laboratory-confirmed COVID-19 patients were included. Up to 21.3% of COVID-19 patients presented neurological symptoms. Headache (5.4%), skeletal muscle injury (5.1%), psychiatric disorders (4.6%), impaired consciousness (2.8%), gustatory/olfactory dysfunction (2.3%), acute cerebrovascular events (1.4%), and dizziness (1.3%), were the most frequently reported neurological manifestations. Ischemic stroke occurred among 1.3% of COVID-19 patients. Other less common neurological manifestations were cranial nerve impairment (0.6%), nerve root and plexus disorders (0.4%), epilepsy (0.7%), and hemorrhagic stroke (0.15%). Impaired consciousness and acute cerebrovascular events were reported in 14% and 4% of patients with a severe disease, respectively, and they were significantly higher compared to non-severe patients (p < 0.05). Individual patient data from 129 COVID-19 patients with acute ischemic stroke (AIS) were extracted: mean age was 64.4 (SD ± 6.2), 78.5% had anterior circulation occlusions, the mean NIHSS was 15 (SD ± 7), and the intra-hospital mortality rate was 22.8%. Admission to the intensive care unit (ICU) was required among 63% of patients. Conclusion This updated review of literature, shows that headache, skeletal muscle injury, psychiatric disorders, impaired consciousness, and gustatory/olfactory dysfunction were the most common neurological symptoms of COVID-19 patients. Impaired consciousness and acute cerebrovascular events were significantly higher among patients with a severe infection. AIS patients required ICU admission in 63% of cases, while intra-hospital mortality rate was close to 23%. Electronic supplementary material The online version of this article (10.1007/s00415-020-10285-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
| | - Caroline Arquizan
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
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