Département de réadaptation, Université Laval, Québec, QC, Canada; Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.
Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.
Ann Emerg Med. 2022 Aug;80(2):154-164. doi: 10.1016/j.annemergmed.2022.01.041. Epub 2022 Mar 16.
To estimate the cumulative incidence of functional decline over 6 months following emergency department (ED) assessments of nonhospitalized injuries and to identify its main determinants.
We conducted a prospective multicenter cohort of older adults discharged home following assessment for injuries in 8 Canadian EDs. Participants were assessed at 3 time points: baseline in the ED, 3 months, and 6 months. The primary outcome, functional decline, was defined as a 2-points loss from baseline on the Older American Resources Scale (OARS). Other measures included demographics, comorbidities, injury characteristics, frailty, cognition, mobility status, etc. Cumulative incidences were estimated using proportions with 95% confidence intervals. Log-binomial regressions and the "least absolute shrinkage and selection operator" (LASSO) were used to identify significant functional decline determinants.
Among 2,919 participants, 403 (13.8%) were lost to follow-up. Mean age was 76.2±7.6 years, 65.3% were women, 9% were frail, and 40.0% prefrail. Main injury mechanisms were falls (65.5%) and motor vehicle accidents (18.6%). The cumulative incidence of functional decline over 6 months was 17.0% (95% confidence interval 12.5% to 23.0%). Occasional use of walking devices, less than 5 outings/week, frailty, and older age were significant baseline determinants of functional decline.
A significant 17% of older adults with "minor" injuries experience a persistent functional decline over 6 months following their ED visit. Four frailty-related determinants were identified: occasional use of a walking device, less than 5 outings/week, frailty, and older age. Further work is needed to assess if these can help ED clinicians screen seniors at risk and initiate interventions at discharge.
评估非住院损伤急诊评估后 6 个月内功能下降的累积发生率，并确定其主要决定因素。
我们对 8 家加拿大急诊室因损伤而出院回家的老年患者进行了前瞻性多中心队列研究。参与者在 3 个时间点进行评估：急诊室基线、3 个月和 6 个月。主要结局是功能下降，定义为老年资源量表（OARS）基线时下降 2 分。其他措施包括人口统计学、合并症、损伤特征、虚弱、认知、移动状态等。使用比例和 95%置信区间估计累积发生率。对数二项式回归和“最小绝对收缩和选择算子”（LASSO）用于识别显著的功能下降决定因素。
在 2919 名参与者中，有 403 名（13.8%）失访。平均年龄为 76.2±7.6 岁，65.3%为女性，9%为虚弱，40.0%为衰弱前期。主要损伤机制为跌倒（65.5%）和机动车事故（18.6%）。6 个月时功能下降的累积发生率为 17.0%（95%置信区间 12.5%至 23.0%）。偶尔使用行走辅助设备、每周少于 5 次外出、虚弱和年龄较大是功能下降的显著基线决定因素。
在急诊就诊后 6 个月，有“轻微”损伤的老年患者中有 17%经历持续的功能下降。确定了 4 个与虚弱相关的决定因素：偶尔使用行走辅助设备、每周外出少于 5 次、虚弱和年龄较大。需要进一步研究以评估这些因素是否可以帮助急诊医生筛选有风险的老年人并在出院时启动干预措施。
