Optimization of the APOP screener to predict functional decline or mortality in older emergency department patients: Cross-validation in four prospective cohorts

Gelder, Jelle de; Lucke, Jacinta A.; Blomaard, Laura C.; Booijen, A M; Fogteloo, A.J.; Anten, Sander; Steyerberg, Ewout W.; Alsma, Jelmer; Schuit, Stephanie C. E.; Brink, Alec Maassen van den; Groot, Bas de; Blauw, Gerard J.; Mooijaart, Simon P.

doi:10.1016/j.exger.2018.06.015

Cited by 38 publications

(42 citation statements)

References 21 publications

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“…The APOP screener identifies the individual risk of 90-day functional decline and/or mortality and signs of impaired cognition for patients aged ≥70 years. The screener consists of nine questions and can be administered within 2 minutes [ 12 ]. We incorporated the screener at the end of the triage-form in the electronic health records (EHRs) of all older patients.…”

Section: Methodsmentioning

confidence: 99%

“…Before implementation, we executed pilot studies with triage-nurses to assess the barriers and facilitators of the APOP screener [ 12 ]. Because incorporation in the EHRs was experienced as the most important facilitator, we addressed this before implementation in routine care.…”

Section: Methodsmentioning

confidence: 99%

“…The ‘Acutely Presenting Older Patient’ (APOP) screener identifies older patients at the highest risk for functional decline and mortality and aids in the recognition of cognitive impairment [ 11 , 12 ]. The APOP screener is tailored for use in everyday ED practice and takes less than 2 minutes to administer directly at presentation [ 12 ]. The aim of the present study was to determine the feasibility and acceptability of the APOP screener in routine ED practice.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

et al. 2020

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Background risk stratification tools for older patients in the emergency department (ED) have rarely been implemented successfully in routine care. Objective to evaluate the feasibility and acceptability of the ‘Acutely Presenting Older Patient’ (APOP) screener, which identifies older ED patients at the highest risk of adverse outcomes within 2 minutes at presentation. Design and setting 2-month prospective cohort study, after the implementation of the APOP screener in ED routine care in the Leiden University Medical Center. Subjects all consecutive ED patients aged ≥70 years. Methods feasibility of screening was assessed by measuring the screening rate and by identifying patient- and organisation-related determinants of screening completion. Acceptability was assessed by collecting experienced barriers of screening completion from triage-nurses. Results we included 953 patients with a median age of 77 (IQR 72–82) years, of which 560 (59%) patients were screened. Patients had a higher probability of being screened when they had a higher age (OR 1.03 (95%CI 1.01–1.06), P = 0.017). Patients had a lower probability of being screened when they were triaged very urgent (OR 0.55 (0.39–0.78), P = 0.001) or when the number of patients upon arrival was high (OR 0.63 (0.47–0.86), P = 0.003). Experienced barriers of screening completion were patient-related (‘patient was too sick’), organisation-related (‘ED was too busy’) and personnel-related (‘forgot to complete screening’). Conclusion with more than half of all older patients screened, feasibility and acceptability of screening in routine ED care is very promising. To further improve screening completion, solutions are needed for patients who present with high urgency and during ED rush hours.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

et al. 2020

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“…Most patients had experienced functional decline before visiting the ED, and did not feel they had recovered to their baseline level after discharge. Older patients have a high risk of functional decline after being discharged from the ED [44,8], and more than half of older patients need help with rehabilitation after discharge [45]. Based on what our participants described, we concluded that patients were passively waiting for recovery and did not consider asking for help with rehabilitation.…”

Section: Discussionmentioning

confidence: 89%

Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

Kolk

Kruiswijk²,

Vroomen

et al. 2020

Preprint

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Background: Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to collect older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.Methods: We performed semi-structured interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling to achieve maximum variation in heterogeneity. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.Results: In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.Conclusions: This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

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“…The following information about patients was collected from the medical record review and the questionnaires: age; sex; marital status; highest level of education (divided into two categories: low [un nished, primary, secondary] and high education [vocational and tertiary studies]); employment; nationality; reason for ED visit (trauma-related or not); mode of ED referral; cognitive impairment (de ned as o cial diagnosis of dementia determined by a geriatrician); active malignancy; homecare; number of caregivers; age adjusted Charlson Comorbidity Index (ACCI) presented as estimated 10-years survival; (13) Acutely Presenting Older Patients (APOP) score (risk of functional decline or mortality in three months); (14) Activities of Daily Living (ADL) KATZ score (15) and Instrumental activities of daily living (IADL) score. (16) The ADL-KATZ score ranges from 0 to 6 and a higher score corresponds with higher dependency.…”

Section: Data Collectionmentioning

confidence: 99%

Prevalence and Risk Factors of Burden Among Caregivers of Older Patients in the Emergency Department The Caregiver Burden of Acutely Presenting Older Patients

Zaalberg¹,

Barten²,

Heugten³

et al. 2020

Preprint

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BACKGROUND The number of older individuals that live independently at home is rising. These older individuals often rely on caregivers who typically have a similar age and health status. Therefore, caregivers may experience a high burden. We determined the prevalence and risk factors of burden among caregivers of older patients in the emergency department (ED). Methods a prospective observational cohort study of primary caregivers of patients aged ≥ 70 years visiting the ED of a Dutch teaching hospital. Structured interviews were conducted with patients and their caregivers. Caregiver burden was measured using the caregiver strain index (CSI). Additionally, data from medical records were extracted to determine potential risk factors. Univariate and multivariate regression analyses were conducted to identify independent determinants for burden. RESULTS A primary caregiver was reported by 200 of 628 included ED patients. The mean age of patients with a caregiver was 82 (SD 6.7) years and the mean age of the caregivers was 66 (SD 12.4) years. Seventy-eight caregivers (39%) experienced a high burden. Multivariate analysis showed a significant association between high caregiver burden and patients with cognitive impairment or dependency for instrumental activities of daily living (IADL) and more self-reported hours of care per day. CONCLUSION Almost 40% of older patients in the ED have a caregiver who experiences a high burden. Formal assessment in the ED may help provide adequate care to the patients and their caregivers.

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Optimization of the APOP screener to predict functional decline or mortality in older emergency department patients: Cross-validation in four prospective cohorts

Cited by 38 publications

References 21 publications

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

Feasibility and acceptability of the ‘Acutely Presenting Older Patient’ screener in routine emergency department care

Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

Prevalence and Risk Factors of Burden Among Caregivers of Older Patients in the Emergency Department The Caregiver Burden of Acutely Presenting Older Patients

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