Maeda Akifumi, Tokoo Yousuke, Konishi Yukari, Okura Azusa, Imai Natsumi, Tabuchi Yuko, Sako Miyuki, Yorozu Katsuhiro
Nursing, Senri Kinran University, Osaka, JPN.
Nursing, Hokusetsu General Hospital, Osaka, JPN.
Cureus. 2024 Nov 29;16(11):e74721. doi: 10.7759/cureus.74721. eCollection 2024 Nov.
Introduction Medical advances and improved living standards have increased life expectancy, and the percentage of older adults is growing rapidly. The proportion of older adults visiting the emergency department (ED) is also increasing. Frailty is recognized as a significant risk factor for adverse outcomes. Thus, emergency nurses need to assess frailty in older patients presenting to the ED. This study aimed to investigate frailty and adverse outcomes among older adults who visited the ED. Materials and methods This was a prospective observational study. The study participants included patients aged 75 years and above who were either transported or self-presented to the ED of a secondary emergency medical institution at a community acute care general hospital. Data, including frailty, vital signs, triage levels, and other variables, were collected using the screener, an adverse outcome prediction tool. Mortality and survival groups of patients were compared. Results The mortality rate as assessed by the use of the adverse outcome prediction tool was significantly higher in the high-risk group than in the low-risk group (P = 0.018). Compared with outcomes in the survival group (n = 374, 95.4%), the 90-day mortality group (n = 18, 4.6%) showed significant differences in the scores, the need for assistance with housekeeping and bathing, and cognitive impairment. Regarding triage levels, no significant differences were observed in the screener-related items between the mortality and survival groups in the urgent category. Conclusions The results of this study showed no significant difference in 90-day mortality rates when comparing triage categories, suggesting the validity of assessing older adults with adverse outcome prediction tools. Therefore, beyond research facilities, during triage, the adverse outcome prediction tool can be used to assess the frailty of older adults, providing healthcare providers with the opportunity for early intervention in older adults who are frail.
引言 医学进步和生活水平的提高延长了预期寿命，老年人的比例正在迅速增长。前往急诊科（ED）就诊的老年人比例也在增加。衰弱被认为是不良结局的一个重要风险因素。因此，急诊护士需要对到急诊科就诊的老年患者进行衰弱评估。本研究旨在调查到急诊科就诊的老年人的衰弱情况及不良结局。
材料与方法 这是一项前瞻性观察性研究。研究参与者包括75岁及以上通过转运或自行前往社区急性护理综合医院二级急救医疗机构急诊科的患者。使用筛查工具（一种不良结局预测工具）收集包括衰弱、生命体征、分诊级别及其他变量的数据。对患者的死亡率和存活组进行比较。
结果 使用不良结局预测工具评估的高危组死亡率显著高于低危组（P = 0.018）。与存活组（n = 374，95.4%）的结局相比，90天死亡率组（n = 18，4.6%）在得分、家务和洗澡所需协助以及认知障碍方面存在显著差异。关于分诊级别，在紧急类别中，死亡率组和存活组之间与筛查工具相关的项目未观察到显著差异。
结论 本研究结果表明，比较分诊类别时90天死亡率无显著差异，这表明使用不良结局预测工具评估老年人的有效性。因此，除了研究机构外，在分诊期间，不良结局预测工具可用于评估老年人的衰弱情况，为医疗保健提供者提供对衰弱老年人进行早期干预的机会。
