Development of a Risk Prediction Screening Tool for Opioid-Prescription Injury (STOP Injury) in Older Adults Initiated on Opioids From the Emergency Department

Abstract Elder abuse is a growing problem where many cases are left unidentified by professionals. For some older adults, the emergency department may be the sole point of care where they have an opportunity to be identified as victims of abuse. However, current methods of screening tend to miss less obvious forms of abuse and may deter older adults from self-reporting due to either a lack of understanding of abuse or fear of potential consequences. VOICES is an innovative, self-administrated, and automated tablet-based tool that combines screening, educational content, and brief motivational interviewing to enhance and improve identification of elder abuse cases. Combining an elder abuse screener and digital coach designed to guide the older adult through a customized pathway to encourage self-identification and self-reporting of abuse, VOICES is a robust tool engineered to place the screening process in the hands of the older adults, rather than the providers. We will discuss preliminary results of the ongoing feasibility study currently being conducted in the ED, which has successfully enrolled over 500 older adults. Current data indicate that 93% of patients find the tool to be satisfying, engaging, and easy to use. Preliminary findings also suggest that older adults who come in with “Little to none” knowledge of elder abuse increase knowledge of abuse after using the tool. In summary, VOICES appears to be a feasible tablet-based screening tool in the emergency department.

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296 Risk-prediction in the Emergency Department: Comparing the Accuracy of Short Frailty Screens to Identify Adverse Healthcare Outcomes among Older Adults

Age and Ageing ◽

10.1093/ageing/afz103.188 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Rónán O'Caoimh

Keyword(s):

Older Adults ◽

Emergency Department ◽

Diagnostic Accuracy ◽

Risk Prediction ◽

Predictive Validity ◽

Nursing Home Admission ◽

Healthcare Outcomes ◽

Term Care ◽

Significant Difference ◽

One Year

Abstract Background Multiple instruments are available to screen for frailty in the Emergency Department (ED). Despite this, few studies have compared their predictive validity among older adults attending ED. This study aimed to investigate the diagnostic accuracy of a variety of different short frailty and risk-prediction instruments to predict 30-day readmission, length of stay (LOS), one-year mortality and institutionalisation. Methods Consecutive patients aged ≥70 attending a university hospital ED were screened and assessed for frailty. Outcomes were obtained from hospital records. The following instruments were compared: the Clinical Frailty Scale (CFS), PRISMA-7, Identification of Seniors at Risk tool, FRAIL scale, Groningen Frailty Indicator (GFI) and Risk Instrument for Screening in the Community (RISC). Results In all, 193 patients were included, median age 79+/-9; 55% were female. Based upon a CGA, 60% (116/193) were classified as frail. Those identified as frail were significantly older (p=0.03) and reported lower quality of life scores (p<0.001). There was no significant difference in co-morbidity using the Charlson Index (p=0.15). The ED conversion rate was 77%, median LOS 8+/-9 days and 20% were re-admitted within 30 days. At one-year, 13.5% were accepted for long-term care and 17% had died. Comparing instruments, the combined RISC was had the highest accuracy based on the area under the ROC curve (AUC) scores for predicting mortality and nursing home admission at one year, AUC 0.77 (95% CI:0.68-0.87) and 0.73 (95% CI:0.64-0.82), respectively. The GFI, CFS and PRISMA-7 had statistically similar, albeit lower scores. No instrument was accurate in predicting 30-day readmission after discharge (AUC <0.70). Conclusion Short frailty screening instruments applied in ED have poor-modest predictive validity for important healthcare outcomes, particularly hospital re-admission. The RISC score had the highest diagnostic accuracy for institutionalisation and death but this was fair at best, suggesting that instrument selection should be pragmatic with the expectation of identifying frailty.

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