A systematic review and recommendations for prom instruments for older people with frailty in emergency care

Oppen, James David van; Alshibani, Abdullah; Coats, Timothy; Graham, Blair; Holch, Patricia; Lalseta, Jagruti; Mackintosh, Nicola; Richardson, Vivien; Riley, Peter; Valderas, José M; Conroy, Simon

doi:10.1186/s41687-022-00438-x

Cited by 13 publications

(10 citation statements)

References 45 publications

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“…One prior systematic review focused specifically on PROM assessments of frail older adults receiving acute hospital care. Our findings support those of the prior review, 85 in that PROMs oriented toward functional status are most commonly used, but also expand to apply these findings to all older adults and specifically to the post–emergency care period. Our work also underscores the emphasis of PROMs measuring physical function and, conversely, the limited use of PROMs to assess other priorities deemed crucial from both patient and provider perspectives 13 .…”

Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

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Patient‐reported outcome measure use among older adults after emergency department care: A systematic review

Gettel,

Galske,

Sather

et al. 2024

Academic Emergency Medicine

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BackgroundPatient‐reported outcome measures (PROMs) are gaining favor in clinical and research settings given their ability to capture a patient's symptom burden, functional status, and quality of life. Our objective in this systematic review was to summarize studies including PROMs assessed among older adults (age ≥ 65 years) after seeking emergency care.MethodsWith the assistance of a medical librarian, we searched Ovid MEDLINE, PubMed, Embase, CINAHL, Web of Science‐Core Collection, and Cochrane CENTRAL from inception through June 2023 for studies in which older adult ED patients had PROMs assessed in the post–emergency care time period. Independent reviewers performed title/abstract review, full‐text screening, data extraction, study characteristic summarization, and risk‐of‐bias (RoB) assessments.ResultsOur search strategy yielded 5153 studies of which 56 met study inclusion criteria. Within included studies, 304 unique PROM assessments were performed at varying time points after the ED visit, including 61 unique PROMs. The most commonly measured domain was physical function, assessed within the majority of studies (47/56; 84%), with measures including PROMs such as Katz activities of daily living (ADLs), instrumental ADLs, and the Barthel Index. PROMs were most frequently assessed at 1–3 months after an ED visit (113/304; 37%), greater than 6 months (91/304; 30%), and 4–6 months (88/304; 29%), with very few PROMs assessed within 1 month of the ED visit (12/304; 4%). Of the 16 interventional studies, two were determined to have a low RoB, four had moderate RoB, nine had high RoB, and one had insufficient information. Of the 40 observational studies, 10 were determined to be of good quality, 20 of moderate quality, and 10 of poor quality.ConclusionsPROM assessments among older adults following an ED visit frequently measured physical function, with very few assessments occurring within the first 1 month after an ED visit.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Patient‐reported outcome measure use among older adults after emergency department care: A systematic review

Gettel,

Galske,

Sather

et al. 2024

Academic Emergency Medicine

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“…As healthcare systems start to operate in more integrated ways (for example, Integrated Care Systems in England30), relatively simple barometers of system-wide urgent care pathway performance might be attractive to policymakers and commissioners. In combination with more person-centred metrics (for example, Patient-Reported Outcome Measures which are being developed for urgent care for older patients living with frailty31 32), the triple metric might help drive more person-centred, system-based emergency care approaches.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with longer wait times, admission and reattendances in older patients attending emergency departments: an analysis of linked healthcare data

et al. 2023

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Background and objectiveCare for older patients in the ED is an increasingly important issue with the ageing society. To better assess the quality of care in this patient group, we assessed predictors for three outcomes related to ED care: being seen and discharged within 4 hours of ED arrival; being admitted from ED to hospital and reattending the ED within 30 days. We also used these outcomes to identify better-performing EDs.MethodsThe CUREd Research Database was used for a retrospective observational study of all 1 039 251 attendances by 368 754 patients aged 75+ years in 18 type 1 EDs in the Yorkshire and the Humber region of England between April 2012 and March 2017. We estimated multilevel logit models, accounting for patients’ characteristics and contact with emergency services prior to ED arrival, time variables and the ED itself.ResultsPatients in the oldest category (95+ years vs 75–80 years) were more likely to have a long ED wait (OR=1.13 (95% CI=1.10 to 1.15)), hospital admission (OR=1.26 (95% CI=1.23 to 1.29)) and ED reattendance (OR=1.09 (95% CI=1.06 to 1.12)). Those who had previously attended (3+ vs 0 previous attendances) were more likely to have long wait (OR=1.07 (95% CI=1.06 to 1.08)), hospital admission (OR=1.10 (95% CI=1.09 to 1.12)) and ED attendance (OR=3.13 (95% CI=3.09 to 3.17)). Those who attended out of hours (vs not out of hours) were more likely to have a long ED wait (OR=1.33 (95% CI=1.32 to 1.34)), be admitted to hospital (OR=1.19 (95% CI=1.18 to 1.21)) and have ED reattendance (OR=1.07 (95% CI=1.05 to 1.08)). Those living in less deprived decile (vs most deprived decile) were less likely to have any of these three outcomes: OR=0.93 (95% CI=0.92 to 0.95), 0.92 (95% CI=0.90 to 0.94), 0.86 (95% CI=0.84 to 0.88). These characteristics were not strongly associated with long waits for those who arrived by ambulance. Emergency call handler designation was the strongest predictor of long ED waits and hospital admission: compared with those who did not arrive by ambulance; ORs for these outcomes were 1.18 (95% CI=1.16 to 1.20) and 1.85 (95% CI=1.81 to 1.89) for those designated less urgent; 1.37 (95% CI=1.33 to 1.40) and 2.13 (95% CI=2.07 to 2.18) for urgent attendees; 1.26 (95% CI=1.23 to 1.28) and 2.40 (95% CI=2.36 to 2.45) for emergency attendees; and 1.37 (95% CI=1.28 to 1.45) and 2.42 (95% CI=2.26 to 2.59) for those with life-threatening conditions. We identified two EDs whose patients were less likely to have a long ED, hospital admission or ED reattendance than other EDs in the region.ConclusionsAge, previous attendance and attending out of hours were all associated with an increased likelihood of exceeding 4 hours in the ED, hospital admission and reattendance among patients over 75 years. These differences were less pronounced among those arriving by ambulance. Emergency call handler designation could be used to identify those at the highest risk of long ED waits, hospital admission and ED reattendance.

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“…A recent review examined PROMs used with those with frailty within emergency and acute settings 13 but to the author’s knowledge, no review has addressed this issue in relation to older people with severe frailty nearing the end of life. The limited evidence exploring the priorities and needs of older people with frailty toward the end of life indicate that their needs are multi-dimensional.…”

Section: Introductionmentioning

confidence: 99%

Understanding the extent to which PROMs and PREMs used with older people with severe frailty capture their multidimensional needs: A scoping review

Howard,

Green,

Harris

et al. 2024

Palliat Med

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Background: Older people with severe frailty are nearing the end of life but their needs are often unknown and unmet. Systematic ways to capture and measure the needs of this group are required. Patient reported Outcome Measures (PROMs) & Patient reported Experience Measures (PREMs) are possible tools to assist this. Aim: To establish whether, and in what ways, the needs of older people living with severe frailty are represented within existing PROMs and PREMs and to examine the extent to which the measures have been validated with this patient group. Design: The scoping review follows the method of Arksey and O’Malley. Results: Seventeen papers from 9 countries meeting the inclusion criteria and 18 multi-dimensional measures were identified: 17 PROMs, and 1 PROM with PREM elements. Seven out of the 18 measures had evidence of being tested for validity with those with frailty. No measure was developed specifically for a frail population. Using the adapted framework of palliative need, five measures covered all five domains of palliative need (IPOS, ICECAP-SCM, PDI, WHOQOL-BREF, WHOQOL-OLD). The coverage of items within the domains varied between the measures. Conclusion: Existing PROMs and PREMs are not well designed for what we know about the needs of older people with severe frailty. Future research should firstly focus on adapting and validating the existing measures to ensure they are fit for purpose, and secondly on developing a better understanding of how measures are used to deliver/better person-centred care.

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A systematic review and recommendations for prom instruments for older people with frailty in emergency care

Cited by 13 publications

References 45 publications

Patient‐reported outcome measure use among older adults after emergency department care: A systematic review

Patient‐reported outcome measure use among older adults after emergency department care: A systematic review

Factors associated with longer wait times, admission and reattendances in older patients attending emergency departments: an analysis of linked healthcare data

Understanding the extent to which PROMs and PREMs used with older people with severe frailty capture their multidimensional needs: A scoping review

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