Frailty and use of health services by older patients following a minor injury

Transcription

1 Frailty and use of health services by older patients following a minor injury N.D. Dattani MD, MJ. Sirois PhD, V. Fillion BSc, B. Batomen MSc, J.S. Lee MD MSc, M. Émond MD MSc

2 Disclosures No conflicts of interest Funding was provided by CIHR

3 Background Prior research An injury leading to an emergency department (ED) visit for a functionally independent older patient in Canada: Does not usually necessitate inpatient admission 1,2 Is associated with 15% functional decline over the following six months 3,4 As functional ability declines the need for health services generally increases 5,6 ED visit = Sentinel event 7

4 Background Frailty Frailty = Reduction of the physiological reserve needed to withstand stressors such as minor injuries 8,9 Increased frailty is associated with: -Advanced age, however not all older patients are frail 8,9 -Increased morbidity -Functional decline after a minor injury 10

5 Objective and Hypothesis Objective: To examine the association between frailty and use of health services within 3 and 6 months following a visit to the ED by a functionally independent older patient for a minor injury Hypothesis: Frail patients are more likely to use health services in this context

6 Methods 8sites Inclusion 65 years old BADL independent Minor trauma Contusion, sprain, simple extremity fracture, soft tissue injury such as laceration, minor thoracic injury, or minor head injury Discharged home Health services usage at 0, 3, and 6 months Hospital services ED visit Day surgery Hospitalization Family physician visit Frailty : CSHA-CFS 1 Very fit 2 Well 3 Well, with treated comorbid disease 4 Apparently vulnerable 5 Mildly frail 6 Moderately frail 7 Severely frail

7 Results Hospital services P<0.05

8 Results Hospitalizations P<0.05 There was no difference in ED visits and day surgeries between frail and non-frail patients at any time point

9 Results Family physician visits P<0.05

10 Conclusions Frail patients used more medical health services both before and after an ED visit for a minor injury Difference in hospitalizations seen in the first three months between frail and nonfrail patients may be preventable Future research should focus on targeted interventions to reduce the use of health services among frail patients following ED visits for minor injuries

11 References 1. Scott V, Pearce M, Pengelly C. Technical report: Injury resulting from falls among Canadians age 65 and over. On the analysis of data from the Canadian Community Health Survey, Cycle 2.1 as presented in Report on senior' falls in Canada. Ottawa, Ont.: Public Health Agency of Canada 2005 Contract No.: Document Number. 2. Bawa H, Brussoni M, De Gagné D, et al. Emergency Department Surveillance System: Seniors injury data report Vancouver, BC: BC Injury Research and Prevention Unit; 2004 Contract No.: Document Number. 3. Sirois MJ, Emond M, Ouellet MC, Perry J, Daoust R, Morin J, et al. Cumulative incidence of functional decline after minor injuries in previously independent older Canadian individuals in the emergency department. J Am Geriatr Soc Oct;61(10): Shapiro MJ, Partridge RA, Jenouri I, Micalone M, Gifford D. Functional decline in independent elders after minor traumatic injury. Acad Emerg Med Jan;8(1): Kiel DP, O'Sullivan P, Teno JM, Mor V. Health care utilization and functional status in the aged following a fall. Med Care Mar;29(3): Leon-Munoz LM, Lopez-Garcia E, Graciani A, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F. Functional status and use of health care services: longitudinal study on the older adult population in Spain. Maturitas Dec 20;58(4): Bernstein E. Repeat visits by elder emergency department patients: sentinel events. Acad Emerg Med Jun;4(6): Clegg A, Toung J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The Lancet. 2013;381: De Lepeleire J, Iliffe S, Mann E, Degryse JM. Frailty: an emerging concept for general practice. Br J Gen Pract May;59(562):e Provencher V, Sirois MJ, Ouellet MC, Camden S, Neveu X, Allain-Boulé N, Emond M; Canadian Emergency Team Initiative on Mobility in Aging. Decline in activities of daily living after a visit to a canadian emergency department for minor injuries in independent older adults: are frail older adults with cognitive impairment at greater risk? J Am Geriatr Soc May;63(5):860-8.

12 Web: Facebook: ceti-mobility

13 Extra slides

14 Methods Prospective cohort study conducted between April 2009 and April 2013 as part of the Canadian Emergency Team Initiative (CETI) research program Conducted in eight teaching ED in six Canadian urban regions (Quebec City, Montreal, Ottawa, Toronto, Hamilton, and Calgary) Frailty measured by the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale, with a score 4 indicating frailty

15 Methods Study population Contusion, sprain, simple extremity fracture, soft tissue injury such as laceration, minor thoracic injury, or minor head injury Patient 65 presenting to the ED with a minor traumatic injury Yes No Ineligible Eating, grooming, dressing, transferring, walking, bathing, and continence Independent for basic activities of daily living No Ineligible Yes Ineligible if discharged to long-term care residence Discharged home after ED visit No Ineligible Yes Eligible for inclusion

16 Methods Study outline Patient recruited into study In-person during the ED visit or over the phone within three days of the ED visit Initial interview In-person or over the phone three months after the ED visit Three month follow-up interview In-person or over the phone six months after the ED visit Six month follow-up interview

17 Methods Statistical analyses Multivariable logistic analysis Between frailty status adjusted for: Sex, Age, Comorbidity (yes or no), Live alone (yes or no), Fracture (yes or no), Cognitive impairment (MOCA <23 or TICS<31) (yes or no) Within frailty status not adjusted

18 Frailty : CSHA-CFS

19 Population : Injuries % ans ans % 25 % 85 ans et + N % 18% Contusion Laceration Sprain Fracture TBI

20 Population : Frailty status 3% SOF 2 % CHSA CFS 9 % 10 % 7 % 19 % 33 % 55 % 28 % 34 % Very fit Well 0 point Well with comorbid 1 point 2 points 3 points Apparently vulnerable Mildly frail Moderately frail MJ Sirois, M Pelletier, M Émond, J Perry, et al. To be submitted

21 Results Initial interview data was obtained for 1,540 patients 1,169 patients provided data at the three month follow-up interview 989 patients provided data at the six month follow-up interview

22 Results - Use of medical health services within the three months prior to inclusion into the study p-value Not frail Frail Number (%) Number (%) Patients Not adjusted Adjusted Hospital 223 (18.03) 81 (27.00) Emergency visit 156 (12.61) 56 (18.67) (<48 hours) Day surgery 39 (3.15) 10 (3.33) Hospitalization or more than 48 hours at ED Family physician 39 (3.15) 19 (6.33) (60.63) 221 (73.67) < 0,0001 <0,0001

23 Results - Use of medical health services within the three months after inclusion into the study p-value Not frail Frail Number (%) Number (%) Patients Not adjusted Adjusted Hospital 149 (15.73) 52 (23.42) Emergency visit 113 (11.93) 33 (14.86) (<48 hours) Day surgery 27 (2.85) 7 (3.15) Hospitalization or more than 48 hours at ED Family physician 16 (1.69) 13 (5.86) (62.51) 159 (71.62)

24 Results - Use of medical health services within the three to six month period after inclusion into the study p-value Not frail Frail Number (%) Number (%) Patients Not adjusted Adjusted Hospital 119 (14.76) 40 (21.86) Emergency visit 80 (9.93) 25 (13.66) (<48 hours) Day surgery 18 (2.23) 4 (2.19) Hospitalization or more than 48 hours at ED Family physician 28 (3.47) 10 (5.46) (59.55) 122 (66.67)

25 Équipe CETI-ICRU Subvention de fonctionnement IRSC : Subvention d équipe émergente : mobilité et vieillissement Subvention catalyseur IRSC : mobilité et vieillissement RQRV, CEVQ, Université Laval