LO14: In emergency department, do serum biomarkers are useful to screen independent frail seniors exposed to functional or mobility impairments after a minor injury?

Introduction: Frailty is a geriatric syndrome conferring a high risk of declining functional capacities. Some serum biomarkers were associated with frailty, but no study has investigated this possible association among community-dwelling seniors with minor injuries in the emergency department (ED). The aim was to determine if ED serum biomarker assay combined with frailty status improve the prediction of 3-months functional or mobility impairments in this population, beyond frailty status alone. Methods: This prospective sub-study of the CETI cohort includes 190 participants (age 65 years, ED consultation within 2 weeks of a minor injury, independent in daily activities 4 weeks prior to injury, and discharged home from EDs). Biomarkers were obtained from blood samples at baseline (ED visit). Normal vs. at risk physiological states were defined according to clinical threshold values. Also, the patients were screened for frailty at baseline) while their functional (OARS scale) and mobility characteristics were assessed at the ED visit and 3 months later. Patients were classified as robust or pre-frail/frail according of the CHSA-CFS and SOF scales. Simple generalized linear models with a binomial distribution and a log link function were used to explore the differences in functional and mobility outcomes at three months across sub-groups (RR). Results: When compared to robust ones, ED pre-frail/frail patients were less functional in their instrumental activities of day living (p=0.004), slower walkers (p=0.02), more frequent users of walking aids (p=0.03), more fearful of falling (p=0.006), went outside their home less often weekly (p=0.004) and had higher abnormal creatinine levels (p=0.02). We observed an overall 3-month functional decline in around 10% of patients combined with worsened mobility characteristics. We found that vitamin D [RR: 0.51 (0.07-3.9)], glucose (RR: 0.27 [(0.03-2.16)]) and creatinine (RR: [1.10 [(0.40-2.97]) modulate the prediction of 3-months mobility impairments. However, ED frailty status with CHSA-CFS and SOF scales clearly remained the stronger predictor of mobility impairments [vitamin DRR: 2.93 (1.12-7.65); glucoseRR: 2.36 (0.85-6.55); creatinine: RR2.06 (1.21-3.53)]. Conclusion: Since they do not improve the prediction of 3-months functional or mobility impairments associated with frailty status, ED biomarker assays are not useful in adequately screening for frailty among independent seniors with minor injuries.

Download Full-text

In the Emergency Department, Are Serum Biomarkers useful to Screen Independent Frail Seniors Exposed to Future Functional Decline or Mobility Impairments after a Minor Injury?

Journal of Gerontology & Geriatric Research ◽

10.4172/2167-7182.1000457 ◽

2017 ◽

Vol 06 (06) ◽

Author(s):

Melissa Blouin ◽

Marie Josee Sirois ◽

Mylene Aubertin Leheudre ◽

Lauren E Griffith ◽

Linda Nadeau ◽

...

Keyword(s):

Emergency Department ◽

Functional Decline ◽

Serum Biomarkers ◽

Mobility Impairments ◽

Minor Injury ◽

A Minor

Download Full-text

P054: Do biomarkers need clinical attention among pre-frail injured seniors seen in the ED

CJEM ◽

10.1017/cem.2017.256 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S96

Author(s):

M. Blouin ◽

M. Sirois ◽

M. Aubertin-Leheudre ◽

L.E. Griffith ◽

L. Nadeau ◽

...

Keyword(s):

Functional Decline ◽

Cross Sectional Study ◽

Serum Biomarkers ◽

Clinical Frailty Scale ◽

Cross Sectional ◽

Insulin Growth Factor ◽

Frailty Status ◽

Reactive Protein ◽

Minor Injuries ◽

A Minor

Introduction: Frailty is associated with functional decline and physiological impairments in seniors with minor injuries. Serum biomarkers have also been suggested as potential markers of these impairments in clinical studies. However, no study has addressed the usefulness of serum biomarkers among pre-frail seniors consulting emergency departments (ED) in order to detect these impairments.Objectives: The purpose of the present study was to explore the association between several serum biomarkers and the frailty status of seniors seen in ED for a minor injury who are at risk of functional decline and 2) assist professionals in clinical decisions while identifying frail seniors in whom interventions should be started in order to prevent potential functional decline. Methods: This cross-sectional study includes 190 seniors retrieved from the larger CETI cohort and discharged home from 4 EDs after treatment of minor injuries. Their frailty status was measured by the Canadian Study of Health & Aging-Clinical Frailty Scale (CSHA-CFS). Then, patients were classified as “Robust” (CHSA-CFS levels 1 and 2) vs. “Pre-frail/Frail” (CHSA-CFS levels ≥3). Biomarkers (Albumin, Creatinine, C-reactive protein (CRP), Vitamin D, Ferritin, Glucose and Insulin-Growth Factor (IGF-1)) were obtained from blood samples. “Normal” vs. “Impaired” (low and/or high) clinical threshold values were used for statistical analyses. Results: The proportion of patients with clinically high creatinine levels (>105 µmol/L for male and >85 µmol/L for female) was higher in Pre-frails/Frails when compared to Robusts (P-value=0.01). Also, regarding IGF-1, we observed that the proportion of patients with lower IGF-1 levels (<50 µg/L) was higher in patients showing Pre-frail/Frail status (P-value=0.01). Finally, a significant correlation was found between frailty status and blood glucose (r=0.22; P-value=0.02) whereas a tendency was noted for CRP level (r=0.14; P-value=0.1). Conclusion: When compared to Robust seniors, Pre-frail/Frail individuals presenting to EDs tend to have physiological dysregulations that may help detect pre-frail status in community-dwellers. Larger prospective studies are needed to specify the usefulness and clinical implications of frailty biomarkers in the continuum of acute elder care.

Download Full-text

Fear of falling in community-dwelling older adults presenting to the emergency department for minor injuries: Impact on return to the ED and future falls

CJEM ◽

10.1017/cem.2020.383 ◽

2020 ◽

Vol 22 (5) ◽

pp. 692-700

Author(s):

Marie-Pier Lanoue ◽

Marie-Josée Sirois ◽

Jeffrey J. Perry ◽

Jacques Lee ◽

Raoul Daoust ◽

...

Keyword(s):

Emergency Department ◽

Fear Of Falling ◽

Strong Predictor ◽

Community Dwelling ◽

Risk Of Falling ◽

Predictive Values ◽

Minor Injury ◽

Increased Risk ◽

Minor Injuries ◽

A Minor

ABSTRACTObjectives1) To characterize mild, moderate, and severe fear of falling in older emergency department (ED) patients for minor injuries, and 2) to assess whether fear of falling could predict falls and returns to the ED within 6 months of the initial ED visit.MethodsThis study was part of the Canadian Emergency and Trauma Initiative (CETI) prospective cohort (2011–2016). Patients ages ≥ 65, who were independent in their basic daily activities and who were discharged from the ED after consulting for a minor injury, were included. Fear of falling was measured by the Short Falls Efficacy Scale International (SFES-I) in order to stratify fear of falling as mild (SFES-I = 7-8/28), moderate (SFES-I = 9-13/28), or severe (SFES-I = 14-28/28). Many other physical and psychological characteristics where collected. Research assistants conducted follow-up phone interviews at 3 and 6 months’ post-ED visit, in which patients were asked to report returns to the ED.ResultsA total of 2,899 patients were enrolled and 2,009 had complete data at 6 months. Patients with moderate to severe fear of falling were more likely to be of ages ≥ 75, female, frailer with multiple comorbidities, and decreased mobility. Higher baseline fear of falling increased the risk of falling at 3 and 6 months (odds ratio [OR]-moderate-fear of falling: 1.63, p < 0.05, OR-severe-fear of falling 2.37, p < 0.05). Fear of falling positive predictive values for return to the ED or future falls were 7.7% to 17%.ConclusionAlthough a high fear of falling is associated with increased risk of falling within 6 months of a minor injury in older patients, fear of falling considered alone was not shown to be a strong predictor of return to the ED and future falls.

Download Full-text

Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

Injury Epidemiology ◽

10.1186/s40621-021-00307-z ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Matthew J Molloy ◽

Wendy Shields ◽

Molly W Stevens ◽

Andrea C Gielen

Keyword(s):

Emergency Department ◽

Pediatric Population ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Short Term ◽

Minor Injury ◽

Minor Injuries ◽

A Minor ◽

The Impact ◽

At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Download Full-text

Correlates of cognitive functioning in independent elderly patients discharged home from the emergency department after a minor injury

International Psychogeriatrics ◽

10.1017/s104161021600065x ◽

2016 ◽

Vol 28 (8) ◽

pp. 1313-1322 ◽

Cited By ~ 4

Author(s):

Marie-Christine Ouellet ◽

Marie-Josée Sirois ◽

Simon Beaulieu-Bonneau ◽

Marie-Ève Gagné ◽

Jacques Morin ◽

...

Keyword(s):

Emergency Department ◽

Elderly Patients ◽

Cognitive Functioning ◽

Significant Proportion ◽

Minor Injury ◽

Memory Problems ◽

Lower Baseline ◽

Minor Injuries ◽

A Minor ◽

Trajectory Of Care

ABSTRACTBackground:The objective of this study was to explore correlates of cognitive functioning of older adults visiting the emergency department (ED) after a minor injury.Methods:These results are derived from a large prospective study in three Canadian EDs. Participants were aged ≥ 65 years and independent in basic activities of daily living, visiting the ED for minor injuries and discharged home within 48 hours (those with known dementia, confusion, and delirium were excluded). They completed the Montreal Cognitive Assessment (MoCA). Potential correlates included sociodemographic and injury variables, and measures of psychological and physical health, social support, mobility, falls, and functional status.Results:Multivariate analyses revealed that male sex, age ≥ 85 years, higher depression scores, slower walking speed, and self-reported memory problems were significantly associated with lower baseline MoCA scores.Conclusions:These characteristics could help ED professionals identify patients who might need additional cognitive evaluations or follow-ups after their passage through the ED. Obtaining information on these characteristics is potentially feasible in the ED context and could help professionals alter favorably elderly's trajectory of care. Since a significant proportion of elderly patients consulting at an ED have cognitive impairment, the ED is an opportunity to prevent functional and cognitive decline.

Download Full-text

MP016: Measuring frailty can help emergency departments identify seniors at risk of functional decline after minor injuries

CJEM ◽

10.1017/cem.2016.157 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S71-S72

Author(s):

N. Allain-Boulé ◽

M. Sirois ◽

L.E. Griffith ◽

M. Émond ◽

B. Batomen Kuimi

Keyword(s):

At Risk ◽

Emergency Departments ◽

Predictive Accuracy ◽

Characteristic Curve ◽

Functional Decline ◽

Community Dwelling ◽

Post Injury ◽

Clinical Frailty Scale ◽

Minor Injuries ◽

A Minor

Introduction: The CETI team has shown that around 18% of otherwise independent seniors remain in a state functional decline up to six months after a minor injury. In that context, frailty may be associated with increased likelihood of decline. As most seniors consult Emergency Departments (EDs) when injured, measuring frailty may help identify those at risk of functional decline. Objectives: This study aims to 1) describe frailty in the sub-group of independent community-dwelling seniors consulting Emergency Departments (ED) for minor injuries, 2) examine the association between frailty and functional decline three months post-injury, 3) ascertain the predictive accuracy of frailty measures and Emergency Physicians’ (EPs) for functional decline. Methods: Prospective cohort in 2011-2013 among 1072 seniors aged ≥ 65, independent in basic daily activities, evaluated in Canadian EDs for minor injuries and discharged home. Frailty was assessed at EDs using the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) and the Study of Osteoporotic Fracture index (SOF). Functional decline was defined as a loss ≥ 2/28 on the Older American Resources Services scale three months post-injury. Generalized mixed models were used to explore differences in functional decline across frailty levels. Areas Under the Receiver operating characteristic curve (AUC) were used to ascertain the predictive accuracy of frailty measures and EPs’ clinical judgement. Results: The SOF and CSHA-CFS were available in 342 and 1058 participants, respectively. The SOF identified 55.6%, 32.7%, 11.7% patients as robust, prefrail and frail. These CSHA-CFS (n=1058) proportions were 51.9%, 38.3% and 9.9%. The 3-month incidence of functional decline was 12.1% (10.0%-14.6%). The AUCs of the CSHA-CFS and the EPs’ were similar (0.548 - 0.777), while the SOF was somewhat higher (0.704 - 0.859). Conclusion: Measuring frailty in community-dwelling seniors with minor injuries in EDs may enhance current risk screening for functional decline. However, before implementation in usual care, feasibility issues such as inter-rater reliability and acceptability of frailty tools in the EDs have to be addressed.

Download Full-text

Exercise Interventions for Community-Dwelling Older Adults Following an Emergency Department Consultation for a Minor Injury

Journal of Aging and Physical Activity ◽

10.1123/japa.2019-0200 ◽

2020 ◽

pp. 1-13

Author(s):

Laurence Fruteau de Laclos ◽

Marie-Josée Sirois ◽

Andréanne Blanchette ◽

Dominic Martel ◽

Joannie Blais ◽

...

Keyword(s):

Older Adults ◽

Health Survey ◽

Short Form ◽

Functional Decline ◽

Community Dwelling ◽

Short Form Health Survey ◽

Minor Injury ◽

Form Health ◽

A Minor ◽

Short Form Health

This study compared effects of exercise-based interventions with usual care on functional decline, physical performance, and health-related quality of life (12-item Short-Form health survey) at 3 and 6 months after minor injuries, in older adults discharged from emergency departments. Participants were randomized either to the intervention or control groups. The interventions consisted of 12-week exercise programs available in their communities. Groups were compared on cumulative incidences of functional decline, physical performances, and 12-item Short-Form health survey scores at all time points. Functional decline incidences were: intervention, 4.8% versus control, 15.4% (p = .11) at 3 months, and 5.3% versus 17.0% (p = .06) at 6 months. While the control group remained stable, the intervention group improved in Five Times Sit-To-Stand Test (3.0 ± 4.5 s, p < .01). The 12-item Short-Form health survey role physical score improvement was twice as high following intervention compared with control. Early exercises improved leg strength and reduced self-perceived limitations following a minor injury.

Download Full-text

Self-Management Behaviours and Change in Frailty Status among Community-Dwelling Older Adults: A National Longitudinal Population-based Cohort Study

10.21203/rs.3.rs-1171960/v1 ◽

2022 ◽

Author(s):

Thi Lien To ◽

Ching-Pyng Kuo ◽

Chih-Jung Yeh ◽

Wen-Chun Liao ◽

Meng-Chih Lee

Keyword(s):

Older Adults ◽

Cohort Study ◽

Chronic Diseases ◽

Community Dwelling ◽

Self Management ◽

Geriatric Syndrome ◽

Frailty Phenotype ◽

Frailty Status ◽

Community Dwelling Older Adults

Abstract Background: Frailty in older adults is a common geriatric syndrome that can be reversed, thus coping strategies for the aging population are essential. Self-management behaviours may represent cost-effective strategies to reverse physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association of self-management behaviours with changes in frailty status over a four-year follow-up period (2007 to 2011).Methods: This data was retrieved from the Taiwan Longitudinal Study of Aging (TLSA), which is a prospective cohort study of 1,283 community-dwelling older adults aged 65 years and older without cognitive impairment. Frailty was assessed based on Fried's frailty phenotype, in which ≥ three criteria indicate frail. Self-management behaviours (maintaining body weight, quitting smoking, drinking less, exercising, diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multivariate logistic regression analyses were used to investigate the associations between self-management behaviours and changes in frailty status.Results: The prevalence of frailty was 8.7% at baseline and 8.1% after four years of follow-up, with 196 (15.3%) deaths. Overall, 74.6% of participants remained in the same state (non-frail or frail), 23.5% worsened (non-frail to frail, including missing data, and frail to death), and only 1.95% improved (frail to non-frail). Being aged ≥ 75-years-old, chronic diseases, and an absence of self-management behaviours were associated with higher risks of frailty at baseline and after follow-up. Exercise was significantly associated with a reversal of frailty in community-dwelling older adults (RR, 3.11; 95% CI, 1.95, 4.95) after adjusting for personal and disease covariates, regardless of whether death was coded as frail or not.Conclusions: Self-management behaviours beneficially reverse frailty status; maintaining regular exercise was especially associated with a reversal of frailty in community-dwelling older adults, even among individuals over 75-years-old and with chronic diseases. Older adults should be encouraged to perform adequate physical exercise to prevent the progression of frailty and ameliorate frailty status.

Download Full-text