Multicenter Study of Case Finding in Elderly Emergency Department Patients

Abstract

Objectives: To assess the feasibility of a brief comprehensive casefinding program for detecting functional, cognitive, and social impairments among elderly ED patients and to estimate the prevalence of unknown, undetected, or untreated impairments elderly patients may have.Methods: A multicenter prospective study conducted at five private and public hospital EDs in five different communities across the country. Patients aged 60 years and older released to their homes during 52 randomly selected evening and weekend shifts between February 1 and April 30, 1993, were eligible for the case-finding program. They were evaluated by medical students who received special training (instructional videotape, supervised examinations, and conference calls) in the administration of a standardized 17-item protocol that included an interview and simple tests of function. The patients' physicians were notified of the screening results and were asked to return a one-month follow-up questionnaire. The physicians answered whether the presumed problem had been confirmed and whether a treatment plan for a new problem had been developed. Results:Patient acceptance of the case-finding program was good; 252 of 338 eligible patients (75%) agreed to participate, and 281 conditions were detected for 242 screened patients (96%). The most frequently reported problems were with: performing the activities of daily living (79%); vision (55%); lack of influenza vaccination (54%); home environment (49%); mental status (46%); general health (41%); falls (40%); and depression (36%). The physicians returned questionnaires for 153 patients (63%); 76 patients (50%) were evaluated at follow-up visits, during which 47 newly identified problems (62%) were confirmed and treatment plans were developed for 25 problems (53%) among 21 patients. A mean time of 17.7 ? 10.2 minutes was required to complete the screen.Conclusions: A brief comprehensive case-finding program for functional, cognitive, and social impairment among elderly ED patients is feasible. The screening uncovered a significant amount of morbidity among older patients visiting EDs.Acad. Emerg. Med. 1995; 2:729-734.

A Profile of Acute Care in an Aging America: Snowball Sample Identification and Characterization of United States Geriatric Emergency Departments in 2013

“…A common problem in proactive screening for problems is that positive screens may not be linked with follow-up for issues that are identified. 12 It is also interesting that time from inception of the geriatric ED was not associated with an increase in selections of any of the items. This suggests that geriatric EDs do not increase number of interventions offered with time.…”

“…1,[8][9][10] Strategies for improved ED elder care range from the education and attitude change of emergency providers to the redesign of ED physical plants and departmental operational changes. [11][12][13][14][15][16] One recent and evolving response to the aging demographic imperative is the development of geriatric EDs. The geriatric ED theoretically provides selected improvements in patient care through specialized services and environmental enhancements.…”

Where health and welfare meet: social deprivation among patients in the emergency department

“…16 Models like an ED-based "social triage center" 17 build upon the current model of medical social work and case management, formalizing and expanding the ED as an outpost of the local public health and welfare office and establishing it as an integrated community resource. Although some efforts at social screening and intervention have been introduced successfully in the ED, [18][19][20] social workers and vital services are often absent at crucial times. 21 Yet, the potential impact of an effective social triage service-including fewer "social" hospital admissions, fewer return ED visits, and more efficient use of nurse and physician time-can offset program expenses substantively.…”

The Domain Management Model-A Tool for Teaching and Management of Older Adults in Emergency Departments

“…In one survey of seniors in EDs, 49% had hazards in their home environments. 12 The social environment encompasses many levels of social interactions, including intimate, friendship, and community relationships. Whether these relationships exist and whether they are positive or negative can be critical to the success or failure of medical interventions that require the help or emotional support of other people.…”