Tanguay Katherine, Nadeau Alexandra, Brousseau Audrey-Anne, Archambault Patrick M, Carmichael Pierre-Hugues, Emond Marcel, Deshaies Jean-Francois, Sirois Marie-Josée, Mowbray Fabrice I, Blanchard Pierre-Gilles, Mercier Eric
Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada.
Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Québec, Canada.
Heliyon. 2024 Aug 3;10(15):e35352. doi: 10.1016/j.heliyon.2024.e35352. eCollection 2024 Aug 15.
Data on the predictors of nonmedical problems (NMP) in older adults attending the emergency department (ED) for low acuity conditions is lacking and could help rapid identification of patients with NMP and integration of these needs into care planning.
To determine the prevalence and predictors of NMP among older adults attending EDs for low acuity conditions.
Prospective cohort study in eight EDs (May-August 2021). We included cognitively intact ≥65 years old adults assigned a low triage acuity (3-5) using the CTAS. A questionnaire focusing on 11 NMP was administered. We used multiple logistic regression to identify predictors of NMP.
Among the 1,061 participants included, the mean age was 77.1 ± 7.6, majority were female, and 41.6 % lived alone. At least one NMP was reported by 704 persons. Prevalence of each NMP: outdoor (41.1 %) and indoor (30.2 %) mobility issues, difficult access to dental care (35.1 %), transportation (4.1 %) and medication (5.4 %), loneliness (29.5 %), food insecurity (10.3 %), financial difficulties (9.5 %), unsafe living situation (4.1 %), physical/psychological violence (3.4 %), and abuse/neglect (3.3 %). Predictors of NMP were: age (OR 1.04 for each additional year), living alone (OR 2.20), pre-existing mental health conditions (OR 3.12), heart failure (OR 1.42), recent surgery/admission (OR 1.75), memory decline (OR 2.76), no family physician (OR 1.74) and consulting for a fall/functional decline (OR 2.48).
Nonmedical problems are frequent among older adults. We need to implement holistic ED processes that integrate these problems into care planning.
缺乏关于因低 acuity 状况前往急诊科（ED）就诊的老年人非医疗问题（NMP）预测因素的数据，而这些数据有助于快速识别患有 NMP 的患者，并将这些需求纳入护理计划。
确定因低 acuity 状况前往急诊科就诊的老年人中 NMP 的患病率及预测因素。
在八个急诊科进行前瞻性队列研究（2021 年 5 月至 8 月）。我们纳入了使用 CTAS 分诊 acuity 为低（3 - 5）的认知功能完好的≥65 岁成年人。发放了一份聚焦 11 项 NMP 的问卷。我们使用多因素逻辑回归来确定 NMP 的预测因素。
在纳入的 1061 名参与者中，平均年龄为 77.1 ± 7.6 岁，大多数为女性，41.6%独自生活。704 人报告了至少一项 NMP。每项 NMP 的患病率：户外（41.1%）和室内（30.2%）行动不便、难以获得牙科护理（35.1%）、交通（4.1%）和用药（5.4%）、孤独（29.5%）、粮食不安全（10.3%）、经济困难（9.5%）、不安全的生活状况（4.1%）、身体/心理暴力（3.4%）以及虐待/忽视（3.3%）。NMP 的预测因素为：年龄（每增加一岁，OR 为 1.04）、独自生活（OR 为 2.20）、既往心理健康状况（OR 为 3.12）、心力衰竭（OR 为 1.42）、近期手术/住院（OR 为 1.75）、记忆力下降（OR 为 2.76）、没有家庭医生（OR 为 1.74）以及因跌倒/功能下降就诊（OR 为 2.48）。
非医疗问题在老年人中很常见。我们需要实施全面的急诊科流程，将这些问题纳入护理计划。
