Geriatric assessment in frail older patients in the emergency department

2013 ◽  
Vol 23 (4) ◽  
pp. 275-282 ◽  
Author(s):  
Cesáreo Fernández-Alonso ◽  
F Javier Martín-Sánchez
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Emergency Care ◽  
Older Patients ◽  
Sufficient Evidence ◽  
Short Term ◽  
Intervention Models ◽  
Patients At Risk ◽  
Geriatric Intervention ◽  
Care Of Elderly

SummaryEmergency care of elderly patients is frequent and complex in the emergency department. Frail older patients have a high risk of poor short-term results following emergency care. There is no practical universal or standardized tool defining frailty. It must be systematically identified in older patients at risk using a screening test, and in those who are positive, a diagnostic scale of frailty or preferably a geriatric scale adapted to emergency care is carried out. An adapted geriatric assessment including brief scales related to clinical, mental, functional and social aspects has been proposed. There are currently no geriatric intervention models with sufficient evidence in frail older patients.

scholarly journals Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a retrospective study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045141
Author(s):  
Paul MEL van Dam ◽  
Noortje Zelis ◽  
Patricia Stassen ◽  
Daan J L van Twist ◽  
Peter W De Leeuw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Adverse Outcome ◽  
Characteristic Curve ◽  
Favourable Outcome ◽  
Secondary Outcome ◽  
Care Hospital ◽  
Short Term ◽  
Short Term Mortality ◽  
Patients At Risk

ObjectiveTo mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score has very good discriminatory value for short-term mortality in older patients in the emergency department (ED). It consists of six readily available items. We hypothesised that the RISE UP score could have discriminatory value for 30-day mortality in ED patients with COVID-19.DesignRetrospective analysis.SettingTwo EDs of the Zuyderland Medical Centre, secondary care hospital in the Netherlands.ParticipantsThe study sample consisted of 642 adult ED patients diagnosed with COVID-19 between 3 March and until 25 May 2020. Inclusion criteria were (1) admission to the hospital with symptoms suggestive of COVID-19 and (2) positive result of the PCR or (very) high suspicion of COVID-19 according to the chest CT scan.OutcomePrimary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).ResultsWithin 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value for 30-day mortality (area under the receiver operating characteristic curve (AUC) 0.77, 95% CI 0.73 to 0.81) and for the composite outcome (AUC 0.72, 95% CI 0.68 to 0.76). Patients with RISE UP scores below 10% (n=121) had favourable outcome (zero deaths and six ICU admissions), while those with scores above 30% (n=221) were at high risk of adverse outcome (46.6% mortality and 19.0% ICU admissions).ConclusionThe RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome and may help guide decision-making and allocating healthcare resources.

scholarly journals Prospective Validation of a Checklist to Predict Short‐term Death in Older Patients After Emergency Department Admission in Australia and Ireland

2018 ◽  
Vol 26 (6) ◽  
pp. 610-620 ◽  
Author(s):  
Magnolia Cardona ◽  
Michael O'Sullivan ◽  
Ebony T. Lewis ◽  
Robin M. Turner ◽  
Frances Garden ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Short Term ◽  
Emergency Department Admission

scholarly journals Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department, a retrospective study

2020 ◽  
Author(s):  
Paul M.E.L. van Dam ◽  
Noortje Zelis ◽  
Patricia M. Stassen ◽  
Daan J.L. van Twist ◽  
Peter W. de Leeuw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Outcome ◽  
Vital Signs ◽  
Favourable Outcome ◽  
Secondary Outcome ◽  
Care Hospital ◽  
Short Term ◽  
Short Term Mortality ◽  
Patients At Risk ◽  
System Information

AbstractObjectiveTo mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed RISE UP score has very good discriminatory value with respect to short-term mortality in older patients in the emergency department (ED). It consists of six items: age, abnormal vital signs, albumin, blood urea nitrogen (BUN), lactate dehydrogenase (LDH), and bilirubin. We hypothesized that the RISE UP score could have discriminatory value with regard to 30-day mortality in ED patients with COVID-19.SettingTwo EDs of the Zuyderland Medical Centre (MC), secondary care hospital in the Netherlands.ParticipantsThe study sample consisted of 642 adult ED patients diagnosed with COVID-19 between March 3rd until May 25th 2020. Inclusion criteria were: 1) admission to the hospital with symptoms suggestive of COVID-19, and 2) positive result of the polymerase chain reaction (PCR), or (very) high suspicion of COVID-19 according to the chest computed tomography (CT) scan.OutcomePrimary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).ResultsWithin 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value with respect to 30-day mortality (AUC 0.77, 95% CI 0.73-0.81), and to the composite outcome (AUC 0.72, 95% CI 0.68-0.76). Patients with RISE UP scores below 10% (121 patients) had favourable outcome (0% mortality and 5% ICU admissions). Patients with a RISE UP score above 30% (221 patients) were at high risk of adverse outcome (46.6% mortality and 19% ICU admissions).ConclusionThe RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome, and may help guiding decision-making and allocating healthcare resources.

Comparison of different risk stratification rules to predict short-term adverse outcomes after syncope in older Chinese adults 

2021 ◽  
Author(s):  
Hong Mu ◽  
Jiexin Liu ◽  
Hefei Tang ◽  
Cheng Huang ◽  
Limin Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Risk Stratification ◽  
Older Patients ◽  
Adverse Outcomes ◽  
Chronic Obstructive Pulmonary Disorder ◽  
Likelihood Ratios ◽  
Short Term ◽  
Predictive Values ◽  
Older Chinese

Abstract Background: Older adults with syncope are commonly treated in the emergency department. Clinical decision rules have been developed to assess syncope patients, but there have been no application or comparative studies in older Chinese cohorts until now. This study aimed to compare the values of five existing rules in predicting the short-term adverse outcomes of older patients. Methods: From September 2018 to February 2021, older Chinese patients (≥60 yr) with syncope admitted to our hospital were investigated and evaluated by the Risk Stratification of Syncope in the Emergency Department (ROSE) rule, the San Francisco Syncope Rule (SFSR), the FAINT rule, the Canadian Syncope Risk Score (CSRS) and the Boston Syncope Criteria (BSC). After a one-month follow-up, the sensitivity, specificity, accuracy, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (PLR), and negative likelihood ratios (NLR) of each aforementioned rule were calculated and compared. Results: A total of 171 patients, with a mean age of 75.65±8.26 years and 48.54% male, were analysed in the study. Fifty-eight patients were reported to have experienced short-term adverse incidents during the month. The neurally mediated syncope group showed a significant sex-specific difference in adverse incidences but the cardiac syncope group did not. There were some factors associated with significant differences in adverse incidences, such as a history of hypertension, congestive heart failure, and chronic obstructive pulmonary disorder, as well as the levels of SpO2, B-type natriuretic peptide (BNP) and troponin T (TnT), while the levels of haemoglobin and creatinine suggested potential significance. In order of the ROSE, SFSR, FAINT, CSRS and BSC rules in the analysis, the sensitivities were 81.03%, 77.59%, 93.10%, 74.14% and 94.83%, the specificities were 86.73%, 84.96%, 38.94%, 60.18% and 56.64%, the NPVs were 89.91%, 88.07%, 91.67%, 81.93% and 95.52%, and the NLRs were 0.22, 0.26, 0.18, 0.43 and 0.09, respectively. Conclusions: This study revealed that the five mentioned rules for syncope risk stratification, with their own characteristics, all showed crucial significance for screening older adults. Therefore, physicians in the emergency department should flexibly understand and judge older patients’ potential risks according to the actual clinical situations.

scholarly journals Using volunteers to improve the experience of older patients in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 514-518
Author(s):  
Brittany Ellis ◽  
Don Melady ◽  
Nicoda Foster ◽  
Samir Sinha ◽  
Vicki Lau ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older Patients ◽  
Median Number ◽  
Adverse Outcomes ◽  
Social Needs ◽  
Poor Patient ◽  
Number Of Patients ◽  
Patients At Risk ◽  
Collection Form ◽  
Therapeutic Activities

ABSTRACTObjectivesThe Maximizing Aging Using Volunteer Engagement in the Emergency Department (MAUVE + ED) program connects specially trained volunteers with older patients whose personal and social needs are not always met within the busy ED environment. The objective of this study was to describe the development and implementation of the MAUVE + ED program.MethodsVolunteers were trained to identify and approach older patients at risk for adverse outcomes, including poor patient experience, and invite such patients to participate in the program. The program is available to all patients >65 years, and those with confusion, patients who were alone, those with mobility issues, and patients with increased length of stay in the ED. Volunteers documented their activities after each patient encounter using a standardized paper-based data collection form.ResultsOver the program's initial 6-month period, the MAUVE + ED volunteers reported a total of 896 encounters with 718 unique patients. The median time (interquartile range [IQR]) a MAUVE volunteer spent with a patient was 10 minutes (IQR = 5, 20), with a range of 1 to 130 minutes. The median number of patients seen per shift was 7 (IQR = 6, 9), with a range of 1 to 16 patients per shift. The most common activities the volunteer assisted with were therapeutic activities/social visits (n = 859; 95.9%), orientation activities (n = 501; 55.9%), and hydration assistance (n = 231; 25.8%). The least common were mobility assistance (n = 36; 4.0%), and vision/hearing assistance (n = 13; 1.5%).ConclusionsPreliminary data suggest the MAUVE + ED volunteers were able to provide additional care to older adults and their families/carers in the ED.

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