Appropriateness of Medication Selection for Older Persons in an Urban Academic Emergency Department

Abstract Background Delirium is frequent though undetected in older patients admitted to the Emergency Department (ED). Aims To develop and validate a delirium risk assessment tool for older persons admitted to the ED Observation Unit (OU). Methods We used data from two samples of 65 + year-old patients, one admitted to the ED of Brescia Hospital (n = 257) and one to the ED of Desio Hospital (n = 107), Italy. Data from Brescia were used as training sample, those collected in Desio as testing one. Delirium was assessed using the 4AT and patients’ characteristic were retrieved from medical charts. Variables found to be associated with delirium in the training sample were tested for the creation of a delirium risk assessment tool. The resulting tool’s performances were assessed in the testing subsample. Results Of all possible scores tested, the combination with the highest discriminative ability in the training sample included: age ≥ 75 years, dementia diagnosis, chronic use of neuroleptics, and hearing impairment. The delirium score exhibited an AUC of 0.874 and 0.893 in the training and testing samples, respectively. For a 1-point increase in the score, the odds of delirium increased more than twice in both samples. Discussion We propose a delirium risk assessing tool that includes variables that can be easily collected at ED admission and that can be calculated rapidly. Conclusion A risk assessment tool could help improving delirium detection in older persons referring to ED.

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Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis

BMJ Open ◽

10.1136/bmjopen-2019-036182 ◽

2020 ◽

Vol 10 (6) ◽

pp. e036182

Author(s):

Megan Doheny ◽

Janne Agerholm ◽

Nicola Orsini ◽

Pär Schön ◽

Bo Burström

Keyword(s):

Emergency Department ◽

Time Series ◽

Time Series Analysis ◽

Integrated Care ◽

Older Persons ◽

Interrupted Time Series ◽

Interrupted Time Series Analysis ◽

Stockholm County ◽

Series Analysis ◽

Ed Visits

ObjectiveTo investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits.DesignInterrupted time series analysis from 2000 to 2015.SettingStockholm County.ParticipantsAll inhabitants 65+ years in Stockholm County on 31 December of each study year.InterventionIC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County.OutcomeRates of hospital-based ED visits.ResultsIC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65–79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years.ConclusionThe implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.

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Socio-demographic differences in the frequent use of emergency department care by older persons: a population-based study in Stockholm County

BMC Health Services Research ◽

10.1186/s12913-019-4029-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Megan Doheny ◽

Janne Agerholm ◽

Nicola Orsini ◽

Pär Schön ◽

Bo Burström

Keyword(s):

Emergency Department ◽

Older Persons ◽

Population Based ◽

Stockholm County ◽

Demographic Differences ◽

Emergency Department Care ◽

Population Based Study ◽

Frequent Use

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14THE EXTENSION OF THE EXISTING OLDER PERSONS ASSESSMENT AND LIAISON (OPAL) SERVICE IN AN EMERGENCY DEPARTMENT

Age and Ageing ◽

10.1093/ageing/afy211.14 ◽

2019 ◽

Vol 48 (Supplement_1) ◽

pp. i1-i15

Author(s):

J Allen ◽

C Mayl ◽

K Bird ◽

J Vale

Keyword(s):

Emergency Department ◽

Older Persons

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216 Integrated Day Hospital for Older Persons in a Primary Care Centre

Age and Ageing ◽

10.1093/ageing/afz103.131 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Fiona McGrath ◽

Sarah Ronayne ◽

Karen McHugh ◽

Mary McDonnell ◽

Elnsari Muataz ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Older Persons ◽

Blood Pressure Monitoring ◽

Rapid Assessment ◽

Population Data ◽

Shared Vision ◽

Primary Care Centre ◽

Day Hospital ◽

Care Centre

Abstract Background To progress with integrated care, for older persons, it was proposed to establish a Day Hospital in a Primary Care Centre. Population data for Co Mayo shows the percentage of those over 65 years, (17.6%), to be significantly higher than the national average In 2018 there were 39,092 attendances to the Emergency Department and approximately 500, per month, were over 75 years. The aim was to develop a pathway from the Emergency Department to the Day Hospital for those 75 years and over who had experienced a fall. Additionally, this included an Early Supported Discharge for hip fracture patients. Methods The Day Hospital was operational 1 day per week with an allocation of funding for a Consultant, Occupational Therapist and assigned Project Manager. Holter and Blood pressure monitoring equipment was purchased. The Home First Team were reassigned to the front door of the hospital and worked with a cANP and a Medical Registrar. A weekly multi-disciplinary forum, inclusive of all stakeholders, developed working relationships, built a shared vision and standardised the approach for the patient cohort. Frailty training was provided specifically to Emergency Department staff. Results The Home First Team saw 541 patients (Jan-Apr 2019) and in collaboration with the Geriatrician streamed those suitable for management to primary care. The Integrated Day Hospital, 1 day per week (Jan-Apr 2019) delivered 55 new assessments plus follow-up appointments. Patient feedback is very positive and specifically highlights ease of access in primary care. Conclusion Establishing a Day Hospital in a Primary Care Centre is an innovative approach and shifts the focus of intervention from acute to primary care. The location is ideal due to a range of disciplines on site, PHN, Dietetics, Psychiatry This is the initial phase, with some pathways in place, and the overall aim is to provide GP access to rapid assessment in Primary Care and thus ensure hospital avoidance where possible.

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