scholarly journals Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study

CJEM ◽  
2020 ◽  
Vol 22 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Jonathan Afilalo ◽  
Salvatore Mottillo ◽  
Xiaoqing Xue ◽  
Antoinette Colacone ◽  
José A. Morais ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Gait Speed ◽  
Prospective Cohort ◽  
Handgrip Strength ◽  
Functional Decline ◽  
Frail Older Adults ◽  
Ed Visits

ABSTRACTBackgroundA growing number of frail older adults are treated in the emergency department (ED) and discharged home. There is an unmet need to identify older adults that are predisposed to functional decline and repeat ED visits so as to target them with proactive interventions.MethodsA prospective cohort study was conducted in patients 75 years or older who were being discharged from the ED. The objective was to test the value of frailty screening tests, namely 5-meter gait speed and handgrip strength, to predict repeat ED visits at 1 and 6 months and functional decline at 1 month using multivariable logistic regression.ResultsAfter excluding 7 patients lost to follow-up, 150 patients were available for analysis. The mean age was 81.1 ± 4.9 years with 51% females, 13% arriving by ambulance, and 67% having at least two comorbid conditions. At ED discharge, 41% of patients were found to have slow gait speed, whereas 23% had weak handgrip strength. After adjustment, only slow gait speed was independently associated with functional decline at 1 month (odds ratio [OR] 1.39 per 0.1 meters/second decrement, 95% confidence interval [CI], 1.12 to 1.72) and repeat ED visits at 6 months (OR 1.20 per 0.1 meters/second decrement, 95% CI, 1.01 to 1.42).ConclusionsGait speed can be feasibly measured at the time of ED discharge to identify frail older adults at risk for early functional decline and subsequent return to the ED. Conversely, grip strength was not found to be associated with functional decline or ED visits.

scholarly journals Screening instruments to predict adverse outcomes for undifferentiated older adults attending the emergency department: Protocol for a prospective cohort study

2021 ◽  
Vol 4 ◽  
pp. 2
Author(s):  
Aoife Leahy ◽  
Gillian Corey ◽  
Aoife O'Neill ◽  
Owen Higginbotham ◽  
Collette Devlin ◽  
...  
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Functional Decline ◽  
Adverse Outcomes ◽  
Screening Tools ◽  
Index Visit

Background: The number of older adults with complex medical comorbidities and functional impairment is increasing throughout the world. Frail older adults frequently attend the Emergency Department (ED) and are at increased risk of adverse outcomes following presentation. A number of screening tools exist that aim to screen older adults for frailty and identify those at risk of functional decline, unscheduled readmission, institutionalisation and mortality. We propose to determine the predictive accuracy of four commonly used screening tools, namely the Identification of Seniors at Risk Screening (ISAR), Clinical Frailty Scale (CFS), Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA 7) and InterRAI ED, to determine adverse events at 30 days and six months among older adults who present to the ED. Methods and analysis: This is a prospective cohort study where patients over the age of 65 will have four screening tools (ISAR, CFS, PRISMA 7, interRAI ED) performed by face-to-face interview with a research nurse during their index visit to one Irish ED. Older adults will be included if they are willing and able to provide written informed consent, have a Manchester Triage Category 2-5 and are resident in the hospital catchment area. Demographic information will be collected at the index visit. A telephone follow up will occur at 30 days and six months, completed by a research nurse who is blinded to the initial assessment. Outcome data will include mortality rates, ED re-attendance, hospital readmission, functional decline and institutionalisation. We will analyse the risk of adverse outcomes using multivariable logistic regression and we will report adjusted risk ratios (RR) with 95% CI. Dissemination: Study findings will be disseminated through publication in peer-reviewed journals and presentations at relevant academic and clinical conferences. National and International gerontology conferences will be targeted.

scholarly journals Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study

2016 ◽  
Vol 67 (2) ◽  
pp. 166-176.e1 ◽  
Author(s):  
Timothy F. Platts-Mills ◽  
Sean A. Flannigan ◽  
Andrey V. Bortsov ◽  
Samantha Smith ◽  
Robert M. Domeier ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Motor Vehicle ◽  
Persistent Pain ◽  
Motor Vehicle Crash ◽  
Vehicle Crash

scholarly journals Do the Positives Through Life Decrease Later-life Frailty?: Positive Psychosocial Resources and Health Status in Older Adult, a Prospective Cohort Study

2020 ◽  
Author(s):  
Kate Gregorevic ◽  
Ruth E Hubbard ◽  
Nancye M Peel ◽  
Wei Tong Lau ◽  
Jethro Wu ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Health Status ◽  
Psychosocial Factors ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Functional Decline ◽  
Hospital Setting ◽  
Later Life ◽  
Health Assets

Abstract Background: Frailty is a known predictor of poorer outcomes for hospitalised older adults, but does not account for all variation in outcomes. Health Assets, which include positive psychosocial factors, have been associated with improved outcomes in the hospital setting. Methods: A prospective cohort study from adults aged 70 and older with an unplanned admission to general medical, orthogeriatric and subacute wards of two hospitals in Australia. 298 participants were recruited with an average age of 84.7. The Health Assets Index (HAI), frailty, functional status and covariates were measured at the time of recruitment. Outcomes were mortality at 30 days and functional decline at the time of discharge. Results: 56.4% of participants had functional decline on discharge from hospital with 30 day mortality of 5.7%. People with a higher number of health assets were less likely to be frail (OR 0.36(95%CI 0.19-0.68)). At 30 days, odds of mortality were highest amongst those with high frailty/high-HAI and low frailty/low-HAI. At low levels of health assets, odds of mortality decreased with increasing frailty but this reversed at high levels of health assets where frailty was associated with increased mortality. Conclusions: Health assets and frailty combine to predict the odds of mortality for older people entering hospital. This highlights the need to consider psychosocial factors in conjunction with health status for older adults.

scholarly journals Health Assets and Frailty: Positive Psychosocial Resources and Health Status in Older Adult, a Prospective Cohort Study

2020 ◽  
Author(s):  
Kate Gregorevic ◽  
Ruth E Hubbard ◽  
Nancye M Peel ◽  
Wei Tong Lau ◽  
Jethro Wu ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Functional Decline ◽  
Improved Outcomes ◽  
The Mean ◽  
Discharge From Hospital ◽  
Post Hoc ◽  
Health Assets

Abstract Background: Although frailty is predictive of poorer outcomes for hospitalised older adults, it does not account for all variation in outcomes. Health assets are protective factors associated with wellbeing that may moderate frailty associated mortality and functional decline Objective: To determine whether frail older adults with a higher number of health assets have improved outcomes Design: Prospective cohort study Methods: Adults aged 70 and older with an unplanned admission to hospital were included. Recruitment took place on general medical, orthogeriatric and subacute wards of two hospitals in Australia. The Health Assets Index (HAI), frailty, functional status and covariates were measured at the time of recruitment. Outcomes were mortality at 30 days and functional decline at the time of discharge. Results: There were 298 participants, with an average age of 84.7 and 66% were women. 80.1% were frail. The mean score on the HAI was 10.86 with a range of 5.5-15. 56.4% of participants had functional decline on discharge from hospital with 30 day mortality of 5.7%. There was an inverse relationship between frailty and health assets. Neither frailty or a higher number of health assets alone predicted outcomes. In a post-hoc analysis to account for interaction, a higher number of health assets was protective against mortality for the least frail. This relationship was reversed at higher levels of frailty. Conclusions: A higher number of Health Assets correlated with a lower level of frailty. Although Health Assets alone did not predict mortality, this relationship may be moderated by frailty.

scholarly journals Health Assets and Frailty: Positive Psychosocial Resources and Health Status in Older Adult, a Prospective Cohort Study

2019 ◽  
Author(s):  
Kate Gregorevic ◽  
Ruth E Hubbard ◽  
Nancye M Peel ◽  
Wei Tong Lau ◽  
Jethro Wu ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Functional Decline ◽  
Improved Outcomes ◽  
The Mean ◽  
Discharge From Hospital ◽  
Post Hoc ◽  
Health Assets

Abstract Background: Although frailty is predictive of poorer outcomes for hospitalised older adults, it does not account for all variation in outcomes. Health assets are protective factors associated with wellbeing that may moderate frailty associated mortality and functional decline Objective: To determine whether frail older adults with a higher number of health assets have improved outcomes Design: Prospective cohort study Methods: Adults aged 70 and older with an unplanned admission to hospital were included. Recruitment took place on general medical, orthogeriatric and subacute wards of two hospitals in Australia. The Health Assets Index (HAI), frailty, functional status and covariates were measured at the time of recruitment. Outcomes were mortality at 30 days and functional decline at the time of discharge. Results: There were 298 participants, with an average age of 84.7 and 66% were women. 80.1% were frail. The mean score on the HAI was 10.86 with a range of 5.5-15. 56.4% of participants had functional decline on discharge from hospital with 30 day mortality of 5.7%. There was an inverse relationship between frailty and health assets. Neither frailty or a higher number of health assets alone predicted outcomes. In a post-hoc analysis to account for interaction, a higher number of health assets was protective against mortality for the least frail. This relationship was reversed at higher levels of frailty. Conclusions: A higher number of Health Assets correlated with a lower level of frailty. Although Health Assets alone did not predict mortality, this relationship may be moderated by frailty.

scholarly journals Health Assets and Frailty: Positive Psychosocial Resources and Health Status in Older Adult, a Prospective Cohort Study

2019 ◽  
Author(s):  
Kate Gregorevic ◽  
Ruth E Hubbard ◽  
Nancye M Peel ◽  
Wei Tong Lau ◽  
Jethro Wu ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Functional Decline ◽  
Improved Outcomes ◽  
The Mean ◽  
Discharge From Hospital ◽  
Post Hoc ◽  
Health Assets

Abstract Background: Although frailty is predictive of poorer outcomes for hospitalised older adults, it does not account for all variation in outcomes. Health assets are protective factors associated with wellbeing that may moderate frailty associated mortality and functional decline Objective: To determine whether frail older adults with a higher number of health assets have improved outcomes Design: Prospective cohort study Methods: Adults aged 70 and older with an unplanned admission to hospital were included. Recruitment took place on general medical, orthogeriatric and subacute wards of two hospitals in Australia. The Health Assets Index (HAI), frailty, functional status and covariates were measured at the time of recruitment. Outcomes were mortality at 30 days and functional decline at the time of discharge. Results: There were 298 participants, with an average age of 84.7 and 66% were women. 80.1% were frail. The mean score on the HAI was 10.86 with a range of 5.5-15. 56.4% of participants had functional decline on discharge from hospital with 30 day mortality of 5.7%. There was an inverse relationship between frailty and health assets. Neither frailty or a higher number of health assets alone predicted outcomes. In a post-hoc analysis to account for interaction, a higher number of health assets was protective against mortality for the least frail. This relationship was reversed at higher levels of frailty. Conclusions: A higher number of Health Assets correlated with a lower level of frailty. Although Health Assets alone did not predict mortality, this relationship may be moderated by frailty.

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