Identification of Seniors at Risk (ISAR) in the emergency room

Older adults (OA) often experience adverse events after an emergency department (ED) visit. Identified OA at risk for adverse outcomes at initial index visit of emergency department care is recommended | International Emergency Nursing

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Image source: Andrea Squatrito – Flickr // CC BY-NC-ND 2.0

Introduction: The Identification of Seniors at Risk (ISAR) is one of the most frequently utilized risk screening tools in emergency departments (ED). The goal of this study was to evaluate the predictive validity of the ISAR screening tool for adverse outcomes in an ED.

Methods: This was a prospective single-center observational study in a Portuguese urban university hospital ED, and included 402 older adults (OA). After triage, baseline sociodemographic and clinic data were collected by the researcher and the ISAR was administered. Baseline ISAR, adverse outcomes (ED revisits and hospital admission) at 30 (early) and 180 (late) days were evaluated.

Results: ISAR screening showed that 308 (76.62%) OAs were at risk (cutoff ≥ 2). High-risk patients were more like to be older, take more medication, have urgent or very urgent ED visits and have longer ED lengths of stay. The high-risk group were more likely to demonstrate both early (OR=2.43, 95% CI 1.35-4.35, p<0.01) and late returns to the ED (AO=1.70, 95% CI 1.04-2.79, p<0.05). The ISAR did not predict any significant variable for hospital admission in 30 or 180 days.

Discussion: The ISAR predicted returns to EDs at 30 and 180 days for OAs at risk, but was unable to predict early or late hospital readmission.

Full reference: de Almeida Tavares, J.P. et al. (2017) Identification of Seniors at Risk (ISAR) in the emergency room: a prospective study. International Emergency Nursing. Published online: 2 June 2017

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One Hospital System’s Journey to Reduce Clostridium Difficile

Delaney, M.B. Journal of Emergency Nursing | Published online: 4 April 2017

A colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.

Image source: Annie Cavanagh – Wellcome Images // CC BY-NC-ND 4.0

Problem: Albert Einstein defines insanity as doing the same thing over again but expecting different results. Although the United States claims to reduce antibiotic abuse, practice strict isolation, and clean meticulously, the burden of Clostridium difficile outpaces goals. Unless innovative approaches are tried, we risk culling elderly, immunosuppressed, and otherwise debilitated populations. Emergency departments are a primary access point for patients who are unable to wait for primary care. As a result, many patients with diarrhea are seen in emergency departments.

Methods: This article describes one hospital system’s quality improvement trial of disposable commode pails (DCPs) for high-acuity patients in 3 of 5 institutions. The rationale was to prevent staff from touching surfaces heavily contaminated with C difficile. Staff members were not to wash or reuse commode buckets between patients. Instead, DCPs were substituted, and only the commode chairs were wiped. For quantitative date, C difficile infections (CDIs) were compared across hospitals. Staff members were surveyed for qualitative data.

Read the full abstract here

Environmental factors and emergency hospital admissions due to Alzheimer’s disease

Culqui, D.R. et al. (2017) Science of The Total Environment. 592(15) pp. 451–457

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Highlights:

  • Alzheimer’s disease (AD) is the most common cause of dementia among older adults
  • Air pollutants may be risk factors regarding the decompensation of AD
  • PM2.5 concentrations are associated with the development and the exacerbation of AD
  • Heat waves can exacerbate Alzheimer’s hospital admissions
  • More epidemiologic studies will be needed to confirm the relation between AD and environmental factors

Read the full abstract here

Adverse outcomes in older adults attending emergency departments

Galvin, R. et al. (2017) Age Ageing. 46(2) pp. 179-186. 

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Background: older adults are frequent users of emergency services and demonstrate high rates of adverse outcomes following emergency care.

Conclusion: the ISAR has modest predictive accuracy and may serve as a decision-making adjunct when determining which older adults can be safely discharged.

Read the full abstract here

Traumatic brain injuries in older adults—6 years of data for one UK trauma centre

Hawley, C. et al. Emergency Medicine Journal. Published Online: 4 January 2017

Objectives: Our aim was to determine the incidence of traumatic brain injury (TBI) in older adults and investigate the relationship between injury characteristics and outcomes.

Conclusions: Patients with TBI represented 45% of all trauma cases meeting TARN inclusion criteria. Falls at home accounted for most TBIs. Most had moderate/severe TBI, yet over half made a good recovery on GOS. Our data indicate that injury prevention initiatives should focus on home safety. Further research is needed to examine rehabilitation and follow-up after hospital discharge.

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Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons

Nagurney, J. M. et al. Annals of Emergency Medicine. Published online: January 6 2017

Study objective: Among older persons, disability and functional decline are associated with increased mortality, institutionalization, and costs. The aim of the study was to determine whether illnesses and injuries leading to an emergency department (ED) visit but not hospitalization are associated with functional decline among community-living older persons.

 

Conclusion: Although not as debilitating as an acute hospitalization, illnesses and injuries leading to an ED visit without hospitalization were associated with a clinically meaningful decline in functional status during the following 6 months, suggesting that the period after an ED visit represents a vulnerable time for community-living older persons.

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Towards the development of a screening tool to enhance the detection of elder abuse and neglect by emergency medical technicians

Cannell, M.B. et al. BMC Emergency Medicine. Published online: 1 June 2016

Background: To develop a screening tool to enhance elder abuse and neglect detection and reporting rates among emergency medical technicians (EMTs). Our primary aim was to identify the most salient indicators of elder abuse and neglect for potential inclusion on a screening tool. We also sought to identify practical elements of the tool that would optimize EMT uptake and use in the field, such as format, length and number of items, and types of response options available.

Methods: Qualitative data were collected from 23 EMTs and Adult Protective Services (APS) caseworkers that participated in one of five semi-structured focus groups. Focus group data were iteratively coded by two coders using inductive thematic identification and data reduction. Findings were subject to interpretation by the research team.

Results: EMTs and APS caseworks identified eight domains of items that might be included on a screening tool: (1) exterior home condition; (2) interior living conditions; (3) social support; (4) medical history; (5) caregiving quality; (6) physical condition of the older adult; (7) older adult’s behavior; and, (8) EMTs instincts. The screening tool should be based on observable cues in the physical or social environment, be very brief, easily integrated into electronic charting systems, and provide a decision rule for reporting guidance to optimize utility for EMTs in the field.

Conclusions: We described characteristics of a screening tool for EMTs to enhance detection and reporting of elder abuse and neglect to APS. Future research should narrow identified items and evaluate how these domains positively predict confirmed cases of elder abuse and neglect.

Read the full article here