An Emergency Medical Services Program to Promote the Health of Older Adults

Shah, Manish N.; Clarkson, Lindsay L.; Lerner, E. Brooke; Fairbanks, Rollin J.; McCann, Robert M.; Schneider, Sandra

doi:10.1111/j.1532-5415.2006.00736.x

Cited by 48 publications

(98 citation statements)

References 25 publications

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“…Although no risk screening tools appear to be used by EMS, one study described how EMS services have attempted to provide more extensive care through screening, education, and referral programs for older patients in an attempt to identify unmet health care needs (Table 2). (21) EMS-based public health promotion programs are rare; however, Shah et al (21) determined that it is feasible for EMS agencies to take on non-traditional roles in public health. In addition, an EMS specific tool is currently in the derivation phase (PERIL -Paramedics Assessing Elders at Risk For Independence Loss).…”

Section: Frailty In Ems Patientsmentioning

confidence: 99%

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

2012

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BackgroundOlder adults use more health-care services per capita than younger age groups and the older adult population varies greatly in its needs. Evidence suggests that there is a critical distinction between relative frailty and fitness in older adults. Here, we review how frailty is described in the pre-hospital literature and in the broader emergency medicine literature.MethodsPubMed was used as the primary database, but was augmented by searches of CINAHL and EMBASE. Articles were included if they focused on patients 60 years and older and implemented a definition of frailty or risk screening tool in the Emergency Medical Services (EMS) or Emergency Department setting.ResultsIn the broad clinical literature, three types of measures can be identified: frailty index measures, frailty scales, and a phenotypic definition. Each offers advantages and disadvantages for the EMS stakeholder. We identified no EMS literature on frailty conceptualization or management, although some risk measures from emergency medicine use terms that overlap with the frailty literature.ConclusionsThere is a paucity of research on frailty in the Emergency Medical Services literature. No research was identified that specifically addressed frailty conceptualization or management in EMS patients. There is a compelling need for further research in this area.

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Section: Frailty In Ems Patientsmentioning

confidence: 99%

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

2012

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“…Our review of titles and abstracts suggested that 138 articles might be eligible. After studying full texts, we confirmed that 13 papers 61,62,66,80,[89][90][91][92][93][94][95][96][97] reporting 12 studies met our inclusion criteria, as detailed in Figure 1. Table 4 summarises the 12 included studies; Tables 5 and 6 describe them in more detail and Table 7 assesses their quality.…”

Section: Inclusionmentioning

confidence: 56%

“…Of the 12 studies, six 61,62,66,80,89,94 came from the UK, four [90][91][92][93] came from the USA, one 97 came from Australia and one 95 came from New Zealand. Study designs comprised two RCTs 61,66 (one of which 61 published a separate paper evaluating cost-effectiveness element of the study), 62 nine cohort studies (of which six did not include a comparator arm 89,[91][92][93]95,97 and three included intervention and control arms 80,90,96 ) and one qualitative study.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…66,80,95 Five studies reported follow-up outcomes for patients receiving a novel intervention (see Table 6). 61,66,80,90,97 Three 66,80,90 used short follow-up periods (14 and 28 days) with limited inclusion of outcome measures in two, 80,90 whereas another collected physical health, quality-of-life and mortality outcomes. 66 One written as two research papers reported outcomes over 12 months; 61,62 but one did not report the period of follow-up.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Study designs comprised two RCTs 61,66 (one of which 61 published a separate paper evaluating cost-effectiveness element of the study), 62 nine cohort studies (of which six did not include a comparator arm 89,[91][92][93]95,97 and three included intervention and control arms 80,90,96 ) and one qualitative study. 94 Of the nine cohort studies, three were retrospective, 92,95,96 five were prospective 80,[89][90][91]97 and one had both prospective (screening) and retrospective (referral) elements. 93 These study characteristics are summarised in Table 4.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate

Snooks

Anthony

Chatters

et al. 2017

Health Technol Assess

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Background: Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services.\ud Objectives: To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use.\ud Design: Cluster randomised controlled trial.\ud Participants: Participating paramedics at three ambulance services in England and Wales were based at stations randomised to intervention or control arms. Participants were aged 65 years and over, attended by a study paramedic for a fall-related emergency service call, and resident in the trial catchment areas.\ud Interventions: Intervention paramedics received a clinical protocol with referral pathway, training and support to change practice. Control paramedics continued practice as normal.\ud Outcomes: The primary outcome comprised subsequent emergency health-care contacts (emergency admissions, emergency department attendances, emergency service calls) or death at 1 month and 6 months. Secondary outcomes included pathway of care, ambulance service operational indicators, self-reported outcomes and costs of care. Those assessing outcomes remained blinded to group allocation.\ud Results: Across sites, 3073 eligible patients attended by 105 paramedics from 14 ambulance stations were randomly allocated to the intervention group, and 2841 eligible patients attended by 110 paramedics from 11 stations were randomly allocated to the control group. After excluding dissenting and unmatched patients, 2391 intervention group patients and 2264 control group patients were included in primary outcome analyses. We did not find an effect on our overall primary outcome at 1 month or 6 months. However, further emergency service calls were reduced at both 1 month and 6 months; a smaller proportion of patients had made further emergency service calls at 1 month (18.5% vs. 21.8%) and the rate per patient-day at risk at 6 months was lower in the intervention group (0.013 vs. 0.017). Rate of conveyance to emergency department at index incident was similar between groups. Eight per cent of trial eligible patients in the intervention arm were referred to falls services by attending paramedics, compared with 1% in the control arm. The proportion of patients left at scene without further care was lower in the intervention group than in the control group (22.6% vs. 30.3%). We found no differences in duration of episode of care or job cycle. No adverse events were reported. Mean cost of the intervention was £17.30 per patient. There were no significant differences in mean resource utilisation, utilities at 1 month or 6 months or quality-adjusted life-years. In total, 58 patients, 25 paramedics and 31 stakeholders participated in focus groups or interviews. Patients were very satisfied ...

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Interventions to increase influenza vaccination rates of those 60 years and older in the community

Thomas

Lorenzetti

2014

Cochrane Database of Systematic Reviews

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An Emergency Medical Services Program to Promote the Health of Older Adults

Abstract: EMS screening of older adults during emergency responses is feasible, but a simple intervention of providing educational materials to patients during emergency responses and faxing notifications to physicians appears insufficient to address patients' needs.

Cited by 48 publications

References 25 publications

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review

Interventions to increase influenza vaccination rates of those 60 years and older in the community

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