Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Can J Nurs Res. 2023 Sep;55(3):404-412. doi: 10.1177/08445621221144667. Epub 2023 Jan 11.
Emergency nurses commonly conduct geriatric assessments in the emergency department (ED). However, little is known about what geriatric syndromes or clinical presentations prompt a nurse to document an identified need for comprehensive geriatric assessment (CGA).
To examine the association between geriatric syndromes, like frailty, and a nurse-identified need for a CGA following emergency care.
We conducted a secondary analysis of a multi-province Canadian cohort from the InterRAI Multinational Cohort Study. We collected data at ED registration from patients 75 years of age and older (n = 2,274) from eight ED sites across Canada between November 2009 and April 2012. Geriatric syndromes were assessed by trained emergency nurses using the interRAI ED Contact Assessment; and we retrospectively calculated the ED frailty index. We employed binary logistic regression to determine the adjusted associations between geriatric syndromes and a nurse-identified need for a CGA.
Approximately one-quarter (28%) of older adults were identified to need a CGA following emergency care. A 0.1 unit increase in the ED frailty index increased the likelihood of a nurse identify a need for CGA (RD: 6.6; 95% CI = 5.5-7.9). Most geriatric syndromes increased the probability of a nurse documenting the need for a CGA.
When assessed by emergency nurses, the identified need for CGA is strongly linked to the presence of geriatric syndromes, including frailty. We provide face validity for the continued use of emergency nurses for screening and assessing older ED patients.
急诊护士常在急诊科进行老年评估。然而，对于哪些老年综合征或临床表现会促使护士记录明确需要进行全面老年评估（CGA），知之甚少。
调查在接受急诊治疗后，护士识别出的老年综合征（如衰弱）与需要 CGA 之间的关联。
我们对来自加拿大多省的国际评估多中心队列研究的一个多省队列进行了二次分析。我们从加拿大 8 个急诊科在 2009 年 11 月至 2012 年 4 月间登记的 75 岁及以上患者（n=2274）中收集数据。由经过培训的急诊护士使用 interRAI ED 接触评估来评估老年综合征；我们回顾性计算了 ED 衰弱指数。我们采用二项逻辑回归来确定老年综合征与护士识别出的 CGA 需求之间的调整关联。
约四分之一（28%）的老年人在接受急诊治疗后被确定需要 CGA。ED 衰弱指数增加 0.1 单位会增加护士识别出需要 CGA 的可能性（RD：6.6；95%CI=5.5-7.9）。大多数老年综合征增加了护士记录需要 CGA 的可能性。
当由急诊护士评估时，CGA 的需求与老年综合征（包括衰弱）的存在密切相关。我们为继续使用急诊护士对老年 ED 患者进行筛查和评估提供了证据支持。
