Emergency Department Stay Associated Delirium in Older Patients*

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Geriatrics ◽

10.3390/geriatrics6020046 ◽

2021 ◽

Vol 6 (2) ◽

pp. 46

Author(s):

Tina Hansen ◽

Rikke Lundsgaard Nielsen ◽

Morten Baltzer Houlind ◽

Juliette Tavenier ◽

Line Jee Hartmann Rasmussen ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Cohort Study ◽

Systemic Inflammation ◽

Older Patients ◽

Time Course ◽

Assessment Tool ◽

Handgrip Strength ◽

Secondary Analysis ◽

Disease Status

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

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Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

Zeitschrift für Gerontologie und Geriatrie ◽

10.1007/s00391-020-01837-9 ◽

2021 ◽

Author(s):

Laura C. Blomaard ◽

Bas de Groot ◽

Jacinta A. Lucke ◽

Jelle de Gelder ◽

Anja M. Booijen ◽

...

Keyword(s):

Emergency Department ◽

High Risk ◽

Older Patients ◽

Screening Program ◽

Admission Rate ◽

Older Patient ◽

Hospital Admission Rate ◽

High Risk Patients ◽

Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

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SPMSQ for risk stratification of older patients in the emergency department

Zeitschrift für Gerontologie und Geriatrie ◽

10.1007/s00391-019-01626-z ◽

2019 ◽

Vol 52 (S4) ◽

pp. 222-228 ◽

Cited By ~ 1

Author(s):

A. Schönstein ◽

H.-W. Wahl ◽

H. A. Katus ◽

A. Bahrmann

Keyword(s):

Emergency Department ◽

Nursing Home ◽

Risk Stratification ◽

Predictive Validity ◽

Older Patients ◽

Area Under The Curve ◽

Composite Endpoint ◽

Adverse Outcomes ◽

Nursing Home Admission ◽

Initial Contact

Abstract Background Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. Objective To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). Method This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. Results The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46–0.63) but at 3 months (AUC 0.61, 95% CI 0.54–0.68), 6 months (AUC 0.63, 95% CI 0.56–0.70) and 12 months (AUC 0.63, 95% CI 0.56–0.70) after initial contact. Conclusion For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.

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The Effect of Frailty on 30‐day Mortality Risk in Older Patients With Acute Heart Failure Attended in the Emergency Department

Academic Emergency Medicine ◽

10.1111/acem.13124 ◽

2017 ◽

Vol 24 (3) ◽

pp. 298-307 ◽

Cited By ~ 27

Author(s):

Francisco Javier Martín‐Sánchez ◽

Esther Rodríguez‐Adrada ◽

Christian Mueller ◽

María Teresa Vidán ◽

Michael Christ ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Acute Heart Failure ◽

Mortality Risk ◽

Older Patients

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Fractures related to falls in older patients attending an emergency department

Australasian Journal on Ageing ◽

10.1111/ajag.12020 ◽

2013 ◽

Vol 32 (1) ◽

pp. 64-64

Author(s):

Peter Gonski ◽

Xuan Ye

Keyword(s):

Emergency Department ◽

Older Patients

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Profiles of Older Patients in the Emergency Department: Findings From the interRAI Multinational Emergency Department Study

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2013.05.008 ◽

2013 ◽

Vol 62 (5) ◽

pp. 467-474 ◽

Cited By ~ 61

Author(s):

Leonard C. Gray ◽

Nancye M. Peel ◽

Andrew P. Costa ◽

Ellen Burkett ◽

Aparajit B. Dey ◽

...

Keyword(s):

Emergency Department ◽

Older Patients

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Nurses’ experiences and expectations of family and carers of older patients in the emergency department

International Emergency Nursing ◽

10.1016/j.ienj.2013.03.007 ◽

2014 ◽

Vol 22 (1) ◽

pp. 31-36 ◽

Cited By ~ 12

Author(s):

Margaret Fry ◽

Robyn Gallagher ◽

Lynne Chenoweth ◽

Jane Stein-Parbury

Keyword(s):

Emergency Department ◽

Older Patients

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Development and validation of a delirium risk assessment tool in older patients admitted to the Emergency Department Observation Unit

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01792-4 ◽

2021 ◽

Author(s):

A. Zucchelli ◽

R. Apuzzo ◽

C. Paolillo ◽

V. Prestipino ◽

S. De Bianchi ◽

...

Keyword(s):

Risk Assessment ◽

Emergency Department ◽

Older Patients ◽

Older Persons ◽

Assessment Tool ◽

Training Sample ◽

Risk Assessment Tool ◽

Observation Unit ◽

Old Patients ◽

Two Samples

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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