No abstract

Background Older adults frequently attend the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. A presentation to an ED can be viewed as an opportunity to assess those at risk of adverse outcomes and initiate a care plan in those deemed as ‘high risk'. Our aim was to evaluate the feasibility of a physiotherapy led integrated care intervention for older adults discharged from the ED (ED-PLUS). Methods Older adults presenting to the ED with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED-PLUS (Trial registration: NCT04983602). ED-PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s own home. Feasibility (recruitment and retention rates) and acceptability of the programme were assessed quantitatively and qualitatively. Functional decline was examined post-intervention using the Barthel Index. All outcomes were assessed by a research nurse blinded to group allocation. Results 29 participants were recruited, indicating 97% of our recruitment target. 90% of participants completed the ED-PLUS intervention. All participants expressed positive feedback about the intervention. The incidence of functional decline at 6 weeks was 10% in the ED-PLUS group versus 70-89% in the usual care and CGA-only groups. Conclusion High adherence and retention rates were observed among participants and preliminary findings indicate a lower incidence of functional decline in the ED-PLUS group. Recruitment challenges existed in the context of COVID-19. Data collection is ongoing for six-month outcomes.

Introduction: Nutrition status among older adults is an important factor in health and clinical outcomes but malnutrition goes unrecognised in routine health care.  Older adults often present to emergency departments (ED) and are subsequently discharged without hospital admission.  Discharge is a transitionary time of care when nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways. This protocol outlines a scoping review to identify the level of nutrition care provided to older adults attending emergency departments. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute. The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Two researchers will search electronic databases (Medline, CINAHL Complete, EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and website searches (Google, Google Scholar, Pubmed, NICE and LENUS) to identify appropriate data for inclusion within the last 10 years. Key information will be categorised and classified to generate a table charting the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model. A narrative synthesis will be conducted. Conclusions: This scoping review will be used to inform a foundational concept of nutrition care in an ED setting and allow the future examination of nutrition care pathways, practice, policy, and research within models of integrated care for older persons.

Introduction: Nutrition status among older adults is an important factor in health and clinical outcomes but malnutrition goes unrecognised in routine health care.  Older adults often present to emergency departments (ED) and are subsequently discharged without hospital admission.  Discharge is a transitionary time of care when nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways. This protocol outlines a scoping review to identify the level of nutrition care provided to older adults attending emergency departments. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute. The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Two researchers will search electronic databases (Medline, CINAHL Complete, EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and website searches (Google, Google Scholar, Pubmed, NICE and LENUS) to identify appropriate data for inclusion within the last 10 years. Key information will be categorised and classified to generate a table charting the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model. A narrative synthesis will be conducted. Conclusions: This scoping review will be used to inform a foundational concept of nutrition care in an ED setting and allow the future examination of nutrition care pathways, practice, policy, and research within models of integrated care for older persons.