Gagnon-Roy Mireille, Hami Benyahia, Généreux Mélissa, Veillette Nathalie, Sirois Marie-Josée, Egan Mary, Provencher Véronique
École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Quebec, Canada.
Faculty of Medicine and Health Sciences, University of Sherbrooke, Research Centre on Aging, Sherbrooke, Quebec, Canada.
BMJ Open. 2018 Apr 17;8(4):e019908. doi: 10.1136/bmjopen-2017-019908.
Older cognitively impaired adults present a higher risk of hospitalisation and mortality following a visit to the emergency department (ED). Better understanding of avoidable incidents is needed to prevent them and the associated ED presentations in community-dwelling adults. This study aimed to synthetise the actual knowledge concerning these incidents leading this population to ED presentation, as well as possible preventive measures to reduce them.
A scoping review was performed according to the Arksey and O'Malley framework.
Scientific and grey literature published between 1996 and 2017 were examined in databases (Medline, Cumulative Index of Nursing and Allied Health, Ageline, Scopus, ProQuest Dissertations/theses, Evidence-based medecine (EBM) Reviews, Healthstar), online library catalogues, governmental websites and published statistics. Sources discussing avoidable incidents leading to ED presentations were included and then extended to those discussing hospitalisation and mortality due to a lack of sources. Data (type, frequency, severity and circumstances of incidents, preventive measures) was extracted using a thematic chart, then analysed with content analysis.
67 sources were included in this scoping review. Five types of avoidable incidents (falls, burns, transport accidents, harm due to self-negligence and due to wandering) emerged, and all but transport accidents were more frequent in cognitively impaired seniors. Differences regarding circumstances were only reported for burns, as scalding was the most prevalent mechanism of injury for this population compared with flames for the general senior population. Multifactorial interventions and implications of other professionals (eg, pharmacist, firefighters) were reported as potential interventions to reduce avoidable incidents. However, few preventive measures were specifically tested in this population.
Primary research that screens for cognitive impairment and involves actors (eg, paramedics) to improve our understanding of avoidable incidents leading to ED visits is greatly needed. This knowledge is essential to develop preventive measures tailored to the needs of older cognitively impaired adults.
认知功能受损的老年人在急诊就诊后住院和死亡风险更高。为预防此类情况及其在社区居住成年人中的相关急诊就诊，需要更好地了解可避免的事件。本研究旨在综合关于导致该人群急诊就诊的这些事件的实际知识，以及减少这些事件的可能预防措施。
根据阿克斯赛和奥马利框架进行了一项范围综述。
在数据库（医学索引数据库、护理及相关健康累积索引、老年医学数据库、Scopus数据库、ProQuest学位论文数据库、循证医学综述、Healthstar数据库）、在线图书馆目录、政府网站和已发布的统计数据中，检索了1996年至2017年期间发表的科学文献和灰色文献。纳入讨论导致急诊就诊的可避免事件的资料来源，然后由于资料来源不足扩展至讨论住院和死亡情况的资料来源。使用主题图表提取数据（事件的类型、频率、严重程度和情况、预防措施），然后进行内容分析。
本范围综述纳入了67个资料来源。出现了五种可避免事件类型（跌倒、烧伤、交通事故、自我疏忽造成的伤害和走失造成的伤害），除交通事故外，所有这些事件在认知功能受损的老年人中更为常见。仅报告了烧伤情况的差异，与一般老年人群因火焰烧伤相比，烫伤是该人群最常见的受伤机制。多因素干预以及其他专业人员（如药剂师、消防员）的作用被报告为减少可避免事件的潜在干预措施。然而，针对该人群专门测试的预防措施很少。
非常需要进行筛查认知功能障碍并让相关人员（如护理人员）参与的初步研究，以增进我们对导致急诊就诊的可避免事件的理解。这些知识对于制定符合认知功能受损老年人需求的预防措施至关重要。
