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

Goldstein, Judah; Andrew, Melissa K.; Travers, Andrew

doi:10.5770/cgj.15.27

Cited by 38 publications

(34 citation statements)

References 44 publications

(79 reference statements)

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“…(32) Additionally, current work practices, guidelines and protocols are biased towards assessment and management of critically ill or injured patients, (32) and currently offer little direction in assessment of frailty as part of routine clinical assessment. (10) Consequently, there is a risk that paramedics' clinical decision making relating to a frail older adult, regardless of their living environment, is based on little objective data and insufficient practice guidelines. (10) Integration into current systems and ease of application of any tool in the clinical environment is an important consideration in paramedic practice.…”

Section: Discussionmentioning

confidence: 99%

“…(2) In regards to ageing, recognition and risk stratification of older adults by degrees of frailty may prove more beneficial than age as a predictor of adverse outcomes. (2,10,11) While associated with disability, comorbidity and age, frailty is its own distinct and dynamic clinical entity. (2) Two predominant approaches of identifying frailty have emerged: the frailty phenotype (FP) (12) and the frailty index (FI).…”

Section: Introductionmentioning

confidence: 99%

“…(23)(24)(25) Identification of a frailty assessment tool applicable to the complex prehospital environment in which paramedics work, and recognised by referral agencies may improve identification of frail and pre-frail older adults, reducing acute hospital presentations through community referral, education and management strategies. (10) The Edmonton Frail Scale (EFS) (26) has been validated by both geriatricians and non-specialist care providers, hence its potential in paramedic assessment of frailty. The EFS samples nine domains representing: cognition, general health, nutrition, independence, social support, medication use, mood, continence and physical functioning.…”

Section: Introductionmentioning

confidence: 99%

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Paramedic assessment of frailty: An exploratory study of perceptions of frailty assessment tools

et al. 2018

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IntroductionFrailty is recognised as a significant variable in the health of older adults. Early identification by paramedics of those at risk of frailty may assist in timely entry to an appropriate clinical care pathway. Early referral to such pathways has been shown to improve patient outcomes and quality of life, as well as deliver economic benefits. To date, little research has been completed regarding assessment of frailty by paramedic professionals using validated assessment tools. The objective of this study was to determine paramedicine students' perceptions of screening tools to facilitate assessment and knowledge of frailty of older adults. The Edmonton Frail Scale (EFS) and the Groningen Frailty Index (GFI) were determined suitable for this purpose. MethodsThe research adopted a mixed methods approach using a survey tool developed to gather both qualitative and quantitative data from students at the completion of a structured aged care clinical placement. Thematic analysis of the qualitative data identified key features of the tools, while a Likert-type scale was used to measure perspectives about the suitability of the tools for use in paramedic practice. ResultsThirty-seven paramedicine students were invited to participate in the study. Thirteen were able to use both tools to conduct frailty assessments and submitted survey responses. Student perspectives indicated both the EFS and GFI are potentially suitable for paramedicine and as clinical learning tools regarding geriatric assessments. Mean time to administer the tools was 13.46 minutes (SD 12.14) for the EFS and 12.19 (SD 9.6) minutes for the GFI. ConclusionsParamedicine students support a frailty assessment tool to assist clinical decision making regarding older adults. Further appraisal of validated frailty assessment tools by operational paramedics in a pre-hospital environment is warranted to determine absolute utility for Australian paramedics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Paramedic assessment of frailty: An exploratory study of perceptions of frailty assessment tools

et al. 2018

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“…These tools may be proxy markers of frailty. 33 General risk-screening tools have been evaluated in the ED, with the two most commonly studied being the Identification of Seniors at Risk (ISAR) 34 and Triage Risk Screening Tool (TRST) 35 . The ISAR is a self-or caregiver-completed, six-item measure administered during the ED visit, either upon early presentation or prior to discharge.…”

Section: Frailty: Screening and Assessmentmentioning

confidence: 99%

The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care

Goldstein

McVey

Ackroyd‐Stolarz

2015

CJEM

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Caring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step. RÉSUMÉLa prestation des soins aux personnes âgées occupe une place importante dans les services médicaux d'urgence (SMU). Les systèmes de SMU étaient conçus au départ pour traiter des affections aiguës isolées, ce qui est très différent des pratiques exemplaires en matière de soins aux personnes âgées fragiles. Le repérage précoce des personnes âgées fragiles, fortement prédisposées à des événements défavorables pourrait améliorer la prestation des soins. Les ambulanciers paramédicaux sont bien placés pour jouer un rôle important dans une évaluation approfondie du degré de fragilité (ou de vulnérabilité), et les résultats obtenus peuvent éclairer les décisions prises par les fournisseurs de services préhospitaliers et, par la suite, dans les services d'urgence (SU). Des programmes innovateurs de SMU, de soins dans les SU et de soins de base pourraient réduire la charge de travail dans les SU tout en améliorant l'accès aux soins et, en dernier ressort, les résultats cliniques. Certaines personnes âgées fragiles pourraient profiter des ressources disponibles dans les SU et du bagage cumulé de connaissances spécialisées, tandis que d'autres profiteraient davantage d'autres solutions, habituellement d'une meilleure coordination des soins de base. Toutefois, cela vaudrait la peine de faire davantage de recherche afin de distinguer les deux groupes. Dans un cas comme dans l'autre, il faudrait donner des soins au bon moment, en plus de déterminer la nécessité de fournir des soins d'urgence ou des soins de courte durée; d'évaluer le...

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“…6 A recent systematic review incorporating 31 studies of frailty in persons aged 65 and older found a prevalence from 4.0 to 17.0% of frailty, markedly increased in subjects older than 80. 19 Although the role of the components of frailty should be universal, it is possible that in the case of Mexico the prevalence of frailty may be influenced by other characteristics, such as inequality in health conditions, sociodemographics or genetic factors. 20 …”

Section: Declaration Of Conflict Of Interestsmentioning

confidence: 99%

Frailty among Mexican community-dwelling elderly: a story told 11 years later.The Mexican Health and Aging Study

Aguilar-Navarro¹,

Amieva²,

Gutiérrez‐Robledo³

et al. 2015

Salud Publica Mex

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Objective. To describe the characteristics and prognosis of subjects classified as frail in a large sample of Mexican community-dwelling elderly. Materials and methods. An eleven-year longitudinal study of 5 644 old adults participating in the Mexican Health and Aging Study (MHAS). Frailty was defined by meeting at least three of the following criteria: weight loss, weakness, exhaustion, slow walking speed and low physical activity. The main outcomes were incident disability and death. Multiple covariates were used to test the prognostic value of frailty. Results. Thirty-seven percent of participants (n = 2 102) met the frailty criteria. Frail participants were significantly older, female, less educated, with more chronic disease, lower income, and poorer self-reported health status, in comparison with their non-frail counterparts. Frailty was a predictor both for disability activities of daily living and for mortality. Conclusion. After a follow-up of more than ten years, the phenotype of frailty was a predictor for adverse health-related outcomes, including ADL disability and death.

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

Cited by 38 publications

References 44 publications

Paramedic assessment of frailty: An exploratory study of perceptions of frailty assessment tools

Paramedic assessment of frailty: An exploratory study of perceptions of frailty assessment tools

The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care

Frailty among Mexican community-dwelling elderly: a story told 11 years later.The Mexican Health and Aging Study

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