Grimmer Karen, Beaton Kate, Kumar Saravana, Hendry Kevan, Moss John, Hillier Susan, Forward John, Gordge Louise
International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
Aust Health Rev. 2013 Jun;37(3):341-7. doi: 10.1071/AH12034.
To estimate the risk of functional decline after discharge for older people presenting to, and discharged from, a large emergency department (ED) of a tertiary hospital.
The cohort was generated by consecutive sampling of non-Indigenous males and females aged 65 years or over or Aboriginal and Torres Strait Islander males and females aged 45 years or more, without diagnosed dementia, who were living independently in the community before presenting at ED and who were not admitted to hospital as an inpatient after presenting to ED. The hospital assessment risk profile (HARP) was administered to all eligible participants. Sociodemographic information was collected.
Approximately 40 patients per day over two 14-week data collection periods were potentially eligible for inclusion in the study. In total, 597 (17.6% of individuals who presented to ED) were eligible, agreed to participate and continued to be eligible on discharge from ED. Their HARP scores suggested that ~52% were at-risk of functional decline (14.1% high risk, 38.5% intermediate risk).
Elderly patients present to and are discharged from ED every day. The routinely administered HARP instrument scores suggested that approximately half these individuals were at-risk of functional decline in one large hospital ED. Given this instrument's moderate diagnostic accuracy, the true figure may be higher. We suggest that all over-65 year olds presenting at ED without being admitted as an inpatient should be considered for routine screening for potential downstream functional decline, and for intervention if indicated. What is known about the topic? Older individuals often present to ED in lieu of consulting a general medical practitioner, and are not admitted to a hospital bed. Patient demographics, functional and mental capacity and reasons for presentation may be flags for functional decline in the coming months. These could be used by ED staff to implement targeted assessment and intervention. What does this paper add? This paper highlights the high percentage of older individuals who, at time of ED presentation, are at-risk of downstream functional decline. What are the implications for practitioners? Older people who are discharged from ED without a hospital admission may 'slip through the net', as an ED presentation presents a limited window of opportunity for ED staff to undertake targeted assessment, and intervention, to address the potential for downstream functional decline. The busy nature of ED, resource implications and the range of presenting conditions of older people may preclude this. This research suggests a reality that a large percentage of older people who present at ED but do not require a subsequent hospital admission have the potential for functional decline after discharge. Addressing this, in terms of specific screening processes and interventions, requires a rethink of hospital and community resources, and relationships.
评估在一家三级医院的大型急诊科就诊并出院的老年人出院后功能衰退的风险。
该队列通过对年龄在65岁及以上的非原住民男性和女性或45岁及以上的原住民和托雷斯海峡岛民男性和女性进行连续抽样产生，这些人未被诊断患有痴呆症，在就诊于急诊科之前独立生活在社区中，且在就诊于急诊科后未作为住院患者入院。对所有符合条件的参与者进行医院评估风险概况（HARP）评估。收集社会人口统计学信息。
在两个为期14周的数据收集期内，每天约有40名患者可能符合纳入研究的条件。总共有597名患者（占就诊于急诊科的个体的17.6%）符合条件，同意参与并在从急诊科出院时仍符合条件。他们的HARP评分表明，约52%的人有功能衰退的风险（14.1%高风险，38.5%中度风险）。
老年患者每天都在急诊科就诊并出院。常规使用的HARP工具评分表明，在一家大型医院急诊科，这些个体中约有一半有功能衰退的风险。鉴于该工具的诊断准确性一般，实际数字可能更高。我们建议，所有在急诊科就诊但未作为住院患者入院的65岁以上老年人都应考虑进行常规筛查，以评估潜在的下游功能衰退情况，并在有指征时进行干预。关于该主题已知的情况是什么？老年人经常前往急诊科而非咨询全科医生，且未入住医院病床。患者的人口统计学特征、功能和心理能力以及就诊原因可能是未来几个月功能衰退的信号。急诊科工作人员可利用这些信息进行有针对性的评估和干预。本文补充了什么？本文强调了在急诊科就诊时存在下游功能衰退风险的老年人的高比例。对从业者有何影响？未住院而从急诊科出院的老年人可能“漏网”，因为急诊科就诊为工作人员提供了有限的机会来进行有针对性的评估和干预，以应对潜在的下游功能衰退。急诊科的繁忙性质、资源影响以及老年人就诊情况的多样性可能会妨碍这一点。这项研究表明，很大一部分在急诊科就诊但不需要随后住院的老年人在出院后有功能衰退的可能性。从具体的筛查流程和干预措施方面解决这个问题，需要重新思考医院和社区的资源以及关系。
