Indicators of paramedic service use by community dwelling older adults

Introduction: Home care clients represent a patient group that may be served through community paramedicine (CP) programs. The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population. This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.Methods: A retrospective cohort study was conducted using regularly collected administrative data. Home care assessment data were supplemented with data on emergency department (ED) visits. Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.Results: Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year. About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation. DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78Conclusion: DIVERT was not developed to consider means of transportation to the ED. The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED. Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted. Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.

Download Full-text

LO13: Characteristics of emergency department visits by community-dwelling older adults who screened positive for elder abuse during home care assessments

CJEM ◽

10.1017/cem.2019.56 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S11 ◽

Cited By ~ 1

Author(s):

E. Mercier ◽

A. Jones ◽

A. Brousseau ◽

J. Hirdes ◽

F. Mowbray ◽

...

Keyword(s):

Older Adults ◽

Home Care ◽

Reporting System ◽

Elder Abuse ◽

Frailty Index ◽

Population Based ◽

Community Dwelling ◽

Care Assessment ◽

Ed Visits ◽

Community Dwelling Older Adults

Introduction: Elder abuse is infrequently detected in the emergency department (ED) and less than 2% are reported to proper law authorities by ED physicians. This study aims to examine the characteristics of community-dwelling older adults who screened positive for elder abuse during home care assessments and the epidemiology of ED visits by these patients relative to other home care patients. Methods: This study utilized a population-based retrospective cohort study of home care patients in Canada between April 1, 2007 and March 31, 2015. Standardized, comprehensive home care assessments were extracted from the Home Care Reporting System. A positive screen for elder abuse was defined as at least one these criteria: fearful of a caregiver; unusually poor hygiene; unexplained injuries; or neglected, abused, or mistreated. Home care assessments were linked to the National Ambulatory Care Reporting System in the regions and time periods in which population-based estimates could be obtained to identify all ED visits within 6 months of the home care assessment. Results: A total of 30,413 from the 2,401,492 patients (1.3%) screened positive for elder abuse during a home care assessment. They were more likely to be male (40.5% versus 35.3%, p < 0.001), to have a cognitive impairment (82.9% versus 65.3%, p < 0.001), a higher frailty index (0.27 versus 0.22, p < 0.001) and to exhibit more depressive symptoms (depression rating scale 1 or more: 68.7% versus 42.7%, p < 0.001). Patient who screened positive for elder abuse were less likely to be independent in activities of daily living (41.9% versus 52.7%, p < 0.001) and reported having fallen more frequently (44.2% versus 35.5%, p < 0.001). Caregiver expressing distress was associated with elder abuse (35.3% versus 18.3%, p < 0.001) but not a higher number of hours caring for the patient. Victims of elder abuse were more likely to attend the ED for low acuity conditions (Canadian triage and acuity scale (CTAS) 4 or 5). Diagnosis at discharge from ED were similar with the exception of acute intoxication that was more frequent in patients who are victims of abuse. Conclusion: Elder abuse is infrequently detected during home care assessments in community-dwelling older adults. Higher frailty index, cognitive impairment, depressive symptoms were associated with elder abuse during homecare assessments. Patients who are victims of elder abuse are attending EDs more frequently for low acuity conditions but ED diagnosis at discharge, except for acute intoxication, are similar.

Download Full-text

Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

Canadian Journal of Nursing Research ◽

10.1177/0844562120949426 ◽

2020 ◽

pp. 084456212094942

Author(s):

Connie Schumacher ◽

Aaron Jones ◽

Andrew P. Costa

Keyword(s):

Emergency Department ◽

Home Care ◽

Service Use ◽

Urinary Catheter ◽

Community Dwelling ◽

Care Needs ◽

Home Care Nursing ◽

Nursing Visit ◽

Ed Visits ◽

Care Nursing

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. Purpose The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. Conclusions The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.

Download Full-text

Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada

Journal of Comorbidity ◽

10.1177/2235042x20963390 ◽

2020 ◽

Vol 10 ◽

pp. 2235042X2096339

Author(s):

Kathryn Fisher ◽

Maureen Markle-Reid ◽

Jenny Ploeg ◽

Amy Bartholomew ◽

Lauren E Griffith ◽

...

Keyword(s):

Older Adults ◽

Home Care ◽

Service Use ◽

Primary Outcome ◽

Controlled Trial ◽

Home Care Services ◽

Community Dwelling ◽

Care Services ◽

And Control ◽

Community Dwelling Older Adults

Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management.

Download Full-text

Paramedics assessing patients with complex comorbidities in community settings: results from the CARPE study

CJEM ◽

10.1007/s43678-021-00153-4 ◽

2021 ◽

Author(s):

Matthew S. Leyenaar ◽

Brent McLeod ◽

Aaron Jones ◽

Audrey-Anne Brousseau ◽

Eric Mercier ◽

...

Keyword(s):

Home Care ◽

Support Services ◽

Home Visit ◽

Community Care ◽

Community Support ◽

Community Dwelling ◽

Living Alone ◽

Care Providers ◽

Community Paramedicine ◽

Community Support Services

Abstract Objectives The aim for this study was to provide information about how community paramedicine home visit programs best “navigate” their role delivering preventative care to frequent 9-1-1 users by describing demographic and clinical characteristics of their patients and comparing them to existing community care populations. Methods Our study used secondary data from standardized assessment instruments used in the delivery of home care, community support services, and community paramedicine home visit programs in Ontario. Identical assessment items from each instrument enabled comparisons of demographic, clinical, and social characteristics of community-dwelling older adults using descriptive statistics and z-tests. Results Data were analyzed for 29,938 home care clients, 13,782 community support services clients, and 136 community paramedicine patients. Differences were observed in proportions of individuals living alone between community paramedicine patients versus home care clients and community support clients (47.8%, 33.8%, and 59.9% respectively). We found higher proportions of community paramedicine patients with multiple chronic disease (87%, compared to 63% and 42%) and mental health-related conditions (43.4%, compared to 26.2% and 18.8% for depression, as an example). Conclusion When using existing community care populations as a reference group, it appears that patients seen in community paramedicine home visit programs are a distinct sub-group of the community-dwelling older adult population with more complex comorbidities, possibly exacerbated by mental illness and social isolation from living alone. Community paramedicine programs may serve as a sentinel support opportunity for patients whose health conditions are not being addressed through timely access to other existing care providers. Protocol registration ISRCTN 58273216.

Download Full-text

Impact of the Outbreak of the COVID-19 Pandemic on Formal and Informal Care of Community-Dwelling Older Adults: Cross-National Clustering of Empirical Evidence from 23 Countries

Sustainability ◽

10.3390/su13137277 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7277

Author(s):

Aviad Tur-Sinai ◽

Netta Bentur ◽

Paolo Fabbietti ◽

Giovanni Lamura

Keyword(s):

Older Adults ◽

Home Care ◽

Informal Care ◽

Home Care Services ◽

Community Dwelling ◽

European Countries ◽

Care Services ◽

The Impact ◽

Community Dwelling Older Adults ◽

Informal Help

The COVID-19 pandemic has been dramatically affecting the life of older adults with care needs and their family caregivers. This study illustrates how the initial outbreak of the pandemic changed the supply of formal and informal care to older adults in European countries and Israel and assesses the resilience of these countries in providing support to their older populations by means of a mix of both types of care. We subjected data from the Survey of Health, Ageing and Retirement in Europe COVID-19 period (SHARE-COVID-19) across 23 European countries (including Israel) to descriptive and cluster analyses. In the first wave of the outbreak, a significant proportion of older adults in European countries received informal help, with an increase in the frequency of informal help received from children, neighbors, friends, or colleagues and a decrease in that received from other relatives. In most countries, difficulties in receiving home care services from professional providers were reported. Seven clusters were identified, reflecting different combinations of changes in the formal/informal care provision. In most countries, informal care is more resilient than home care services that formal providers deliver. Since they are an essential source for sustainable care, their challenges related to care should be addressed. The impact of the pandemic does not follow the traditional characterization of welfare regimes. A clustering effort may yield more understanding of the priorities that future care policies should exhibit at the national level and may identify potential systems for policymakers to enhance sustainability of care for community-dwelling older adults.

Download Full-text

Swallowing disorders and 1-year functional decline in community-dwelling older adults receiving home care

Journal of Oral Rehabilitation ◽

10.1111/joor.12577 ◽

2017 ◽

Vol 44 (12) ◽

pp. 982-987 ◽

Cited By ~ 1

Author(s):

K. Takeuchi ◽

M. Furuta ◽

Y. Okabe ◽

S. Suma ◽

T. Takeshita ◽

...

Keyword(s):

Older Adults ◽

Home Care ◽

Functional Decline ◽

Swallowing Disorders ◽

Community Dwelling ◽

Community Dwelling Older Adults

Download Full-text

Physical Activity Level Following Resistance Training in Community-Dwelling Older Adults Receiving Home Care: Results from a Cluster-Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136682 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6682

Author(s):

Hilde Bremseth Bårdstu ◽

Vidar Andersen ◽

Marius Steiro Fimland ◽

Lene Aasdahl ◽

Hilde Lohne-Seiler ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Resistance Training ◽

Home Care ◽

Community Dwelling ◽

Activity Level ◽

Group Differences ◽

Control Group ◽

Cluster Randomized ◽

Community Dwelling Older Adults

Older adults’ physical activity (PA) is low. We examined whether eight months of resistance training increased PA level in community-dwelling older adults receiving home care. A two-armed cluster-randomized trial using parallel groups was conducted. The included participants were >70 years and received home care. The resistance training group performed resistance training using body weight, elastic bands, and water canes twice per week for eight months. The control group was informed about the national PA guidelines and received motivational talks. The ActiGraph GT3X+ accelerometer was used to estimate PA. Outcomes included total PA (counts per minute), sedentary behavior (min/day), light PA (min/day), moderate-to-vigorous PA (min/day), and steps (mean/day). Between-group differences were analyzed using multilevel linear mixed models. Twelve clusters were randomized to either resistance training (7 clusters, 60 participants) or the control group (5 clusters, 44 participants). A total of 101 participants (median age 86.0 (interquartile range 80–90) years) had valid accelerometer data and were included in the analysis. There were no statistically significant between-group differences for any of the PA outcomes after four or eight months. This study offers no evidence of increased PA level following resistance training in older adults with home care.

Download Full-text

A Pilot Study to Test the Feasibility of a Home Mobility Monitoring System in Community-Dwelling Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16091512 ◽

2019 ◽

Vol 16 (9) ◽

pp. 1512 ◽

Cited By ~ 2

Author(s):

Heesook Son ◽

Hyerang Kim

Keyword(s):

Older Adults ◽

Monitoring System ◽

Health Care Providers ◽

Community Dwelling ◽

Care Providers ◽

Remote Communication ◽

Baseline Activity ◽

Home Based ◽

Health Related ◽

Community Dwelling Older Adults

Technology enables home-based personalized care through continuous, automated, real-time monitoring of a participant’s health condition and remote communication between health care providers and participants. Technology has been implemented in a variety of nursing practices. However, little is known about the use of home mobility monitoring systems in visiting nursing practice. Therefore, the current study tested the feasibility of a home mobility monitoring system as a supportive tool for monitoring daily activities in community-dwelling older adults. Daily mobility data were collected for 15 months via home-based mobility monitoring sensors among eight older adults living alone. Indoor sensor outputs were categorized into sleeping, indoor activities, and going out. Atypical patterns were identified with reference to baseline activity. Daily indoor activities were clearly differentiated by sensor outputs and sensor outputs discriminated atypical activity patterns. During the year of monitoring, a health-related issue was identified in a participant. Our findings indicate the feasibility of a home mobility monitoring system for remote, continuous, and automated assessment of a participant’s health-related mobility patterns. Such a system could be used as a supportive tool to detect and intervene in the case of problematic health issues.

Download Full-text

MP34: Elder abuse in the emergency department: a systematic scoping review

CJEM ◽

10.1017/cem.2019.169 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S54-S55

Author(s):

E. Mercier ◽

A. Nadeau ◽

A. Brousseau ◽

M. Emond ◽

J. Lowthian ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Physical Abuse ◽

Health Care Providers ◽

Scoping Review ◽

Elder Abuse ◽

Community Dwelling ◽

Screening Tools ◽

Care Providers

Introduction: This systematic scoping review aims to synthetize the available evidence on the epidemiology, risk factors, clinical characteristics, screening tools, prevention strategies, interventions and knowledge of health care providers regarding elder abuse in the emergency department (ED). Methods: A systematic literature search was performed using three databases (Medline, Embase and Cochrane Library). Grey literature was scrutinized. Studies were considered eligible when they were observational studies or randomized control trials reporting on elder abuse in the prehospital and/or ED setting. Data extraction was performed independently by two researchers and a qualitative approach was used to synthetize the findings. Results: A total of 443 citations were retrieved from which 58 studies published between 1988 and 2018 were finally included. Prevalence of elder abuse following an ED visit varied between 0.01% and 0.03%. Reporting of elder abuse to proper law authorities by ED physicians varied between 2% to 50% of suspected cases. The most common reported type of elder abuse detected was neglect followed by physical abuse. Female gender was the most consistent factor associated with elder abuse. Cognitive impairment, behavioral problems and psychiatric disorder of the patient or the caregiver were also associated with physical abuse and neglect as well as more frequent ED consultations. Several screening tools have been proposed, but ED-based validation is lacking. Literature on prehospital- or ED-initiated prevention and interventions was scarce without any controlled trial. Health care providers were poorly trained to detect and care for older adults who are suspected of being a victim of elder abuse. Conclusion: Elder abuse in the ED is an understudied topic. It remains underrecognized and underreported with ED prevalence rates lower than those in community-dwelling older adults. Health care providers reported lacking appropriate training and knowledge with regards to elder abuse. Dedicated ED studies are required.

Download Full-text