Leveraging emergency department visits to connect older adults at risk for malnutrition and food insecurity to community resources: design and protocol development for the BRIDGE study

Morris, Alvin L.; Anderson, Jessa K. Engelberg; Schmitthenner, Brenda; Aylward, Aileen; Shams, R.; Hurka-Richardson, Karen; Platts‐Mills, Timothy F.

doi:10.1186/s40814-020-00576-3

Cited by 4 publications

(12 citation statements)

References 36 publications

(52 reference statements)

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“…We identified 29 relevant publications 25 observational studies 549 – 574 ; two interventional studies, 575 , 576 ; and two commentary publications. 577 , 578 Objectives among observational studies included the following: food insecurity prevalence (27%) 555 , 560 – 562 , 564 , 565 , 567 ; ED utilization (19%) 549 , 550 , 552 , 570 , 571 ; screening (8%), 553 , 572 ; and cost of care (12%). 550 , 559 , 561 Four (15%) publications explored the health consequences of food insecurity.…”

Section: Resultsmentioning

confidence: 99%

A Scoping Review of Current Social Emergency Medicine Research

Shah

Porta

Leung

et al. 2021

WestJEM

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Introduction: Social emergency medicine (EM) is an emerging field that examines the intersection of emergency care and social factors that influence health outcomes. We conducted a scoping review to explore the breadth and content of existing research pertaining to social EM to identify potential areas where future social EM research efforts should be directed. Methods: We conducted a comprehensive PubMed search using Medical Subject Heading terms and phrases pertaining to social EM topic areas (e.g., “homelessness,” “housing instability”) based on previously published expert consensus. For searches that yielded fewer than 100 total publications, we used the PubMed “similar publications” tool to expand the search and ensure no relevant publications were missed. Studies were independently abstracted by two investigators and classified as relevant if they were conducted in US or Canadian emergency departments (ED). We classified relevant publications by study design type (observational or interventional research, systematic review, or commentary), publication site, and year. Discrepancies in relevant publications or classification were reviewed by a third investigator. Results: Our search strategy yielded 1,571 publications, of which 590 (38%) were relevant to social EM; among relevant publications, 58 (10%) were interventional studies, 410 (69%) were observational studies, 26 (4%) were systematic reviews, and 96 (16%) were commentaries. The majority (68%) of studies were published between 2010–2020. Firearm research and lesbian, gay, bisexual, transgender, and queer (LGBTQ) health research in particular grew rapidly over the last five years. The human trafficking topic area had the highest percentage (21%) of interventional studies. A significant portion of publications -- as high as 42% in the firearm violence topic area – included observational data or interventions related to children or the pediatric ED. Areas with more search results often included many publications describing disparities known to predispose ED patients to adverse outcomes (e.g., socioeconomic or racial disparities), or the influence of social determinants on ED utilization. Conclusion: Social emergency medicine research has been growing over the past 10 years, although areas such as firearm violence and LGBTQ health have had more research activity than other topics. The field would benefit from a consensus-driven research agenda.

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Section: Resultsmentioning

confidence: 99%

A Scoping Review of Current Social Emergency Medicine Research

Shah

Porta

Leung

et al. 2021

WestJEM

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“…Specifically, Table 2 provides information on patient population demographics and health conditions underpinning SDH clinical assessments, Table 3 lists various SDH screening tools used in clinical settings, Table 4 identifies various reasons for SDH integration, and finally, Supplementary Materials Table S1 lists the study design of the articles included in this review, method of integration, type of healthcare facility and its geographic location. Berkman-Syme Social Network Index, SNI (on social isolation) [56] BRFSS Survey-Behavior Risk Factor Surveillance System (1-3-item food insecurity questions) [26] CLEAR Toolkit-Community Leadership on the Environment, Advocacy, and Resilience (four-step process for assessing patient vulnerability in a contextually appropriate and caring way) [86] Family Needs Screening Tool (28-33-item survey) [87] HARK Tool-Humiliation, Afraid, Rape, Kick (four-item survey) [56] Health Begins Upstream Risks Screening Tool (28-item survey) [87] Health Leads Social Needs Screening Toolkit (seven-item survey) [63,81] HITS Screening Tool-Hurt-Insult-Threaten-Scream (12-item survey) [55] HVS-Hunger Vital Sign (two-item survey) [26,58,68,75] iHELP/iHELLP Social History Tool-Income/Insurance-Hunger/Housing Conditions/Homeless-Education/Ensuring Safety-Legal Status, Literacy-Personal Safety (14-24-item survey) [76] iScreen Social Screening Questionnaire (46-item survey) [87] MST-Malnutrition Screening Tool (two-item survey) [68] NASEM-National Academies of Sciences, Engineering, and Medicine (one-item measure of financial strain) [56] NHIS-National Health Interview Survey, a CDC-NCHS SDH assessments in clinical settings focused primarily on vulnerable, disadvantaged, at-risk, and/or socially isolated patients. These patients came from communities experiencing persistent socio-economic challenges, material deprivation, food insecurity, housing instability, and/or toxic stress.…”

Section: Resultsmentioning

confidence: 99%

“…The next three most common screening tools were the Hunger Vital Sign (HVS), Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRA-PARE), and the Safe Environment for Every Kid Parent Questionnaire-R (SEEK PQ-R). The two-item, single domain HVS, is a validated tool that has been used in medical and community settings nationwide for assessing food insecurity in families with young children, adolescents, and older adults [26,68,71,75]. PRAPARE is a 21-item, 21-domain, validated, and nationally standardized tool that evaluates 21 social drivers of health in five core categories, and is designed for adult respondents.…”

Section: Integrating Sdh In Clinical Settings By Study Design Methods...mentioning

confidence: 99%

Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings

Novilla,

Goates,

Leffler

et al. 2023

IJERPH

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Despite the substantial health and economic burdens posed by the social determinants of health (SDH), these have yet to be efficiently, sufficiently, and sustainably addressed in clinical settings—medical offices, hospitals, and healthcare systems. Our study contextualized SDH application strategies in U.S. clinical settings by exploring the reasons for integration and identifying target patients/conditions, barriers, and recommendations for clinical translation. The foremost reason for integrating SDH in clinical settings was to identify unmet social needs and link patients to community resources, particularly for vulnerable and complex care populations. This was mainly carried out through SDH screening during patient intake to collect individual-level SDH data within the context of chronic medical, mental health, or behavioral conditions. Challenges and opportunities for integration occurred at the educational, practice, and administrative/institutional levels. Gaps remain in incorporating SDH in patient workflows and EHRs for making clinical decisions and predicting health outcomes. Current strategies are largely directed at moderating individual-level social needs versus addressing community-level root causes of health inequities. Obtaining policy, funding, administrative and staff support for integration, applying a systems approach through interprofessional/intersectoral partnerships, and delivering SDH-centered medical school curricula and training are vital in helping individuals and communities achieve their best possible health.

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“…The multidimensional nature of older adult food insecurity, and its association with multiple negative health outcomes, also means that clinicians have to address the consequences, often without recognizing that this is the underlying cause (36). Through understanding the drivers and the prevalence within a specific service area, clinical personnel can prioritize screening for food insecurity and referrals to appropriate services that can help maintain health and extend independent living (37). By assessing older adults for food insecurity, health care providers can help overcome stigmas, tailor clinical care to real patient needs, and potentially reduce health care costs by reducing preventable emergency visits and hospitalizations (38).…”

Section: Discussionmentioning

confidence: 99%

Development of Older Adult Food Insecurity Index to Assess Food Insecurity of Older Adults

Lee

Shen

Nishita

2022

The Journal of nutrition, health and aging

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Objectives Quantifying the number of older adults that are food insecure in a specific geographic area is critical in developing and scaling public health prevention and response programs at the local level. However, current estimates of older adult food insecurity only consider financial constraints, following the same methodology as the general population, even though the drivers for older adults are different and multidimensional. This study aims to build a general approach to quantify the food-insecurity among older adults at the local level, using publicly available data that can be easily obtained across the country. Methods 13 risk factors for food insecurity among older adults were identified leveraging existing studies, following the Social Ecological Model (SEM), and the weighted impact of each factor was determined. Publicly available data sources were identified for each factor, ZIP code level data was compared to national averages, and the weighted data for each factor were aggregated to determine the overall food insecurity at the local level. Results Based on the averaged odds ratios across all the studies, of the 13 risk factors, beyond financial constraints, having a disability was the most impactful factor and distance to the nearest grocery store was the least impactful. A ZIP code level model of Honolulu County was developed as an example to demonstrate the approach, showing that food insecurity among older adults in the county was 2.5 times that which was reported from the Current Population Survey (16.5% versus 6.5%). Conclusion This evidence-based model considered factors that impact food insecurity among older adults across all the spheres of the SEM. The drivers of food insecurity among older adults are different than the drivers for the general population, resulting in a higher percentage of older adults being food insecure than currently reported.

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Leveraging emergency department visits to connect older adults at risk for malnutrition and food insecurity to community resources: design and protocol development for the BRIDGE study

Cited by 4 publications

References 36 publications

A Scoping Review of Current Social Emergency Medicine Research

A Scoping Review of Current Social Emergency Medicine Research

Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings

Development of Older Adult Food Insecurity Index to Assess Food Insecurity of Older Adults

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