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?

Provencher, Véronique; Sirois, Marie-Josée; Ouellet, Marie‐Christine; Camden, Stéphanie; Neveu, Xavier; Allain-Boulé, Nadine; Émond, Marcel

doi:10.1111/jgs.13389

Cited by 63 publications

(48 citation statements)

References 42 publications

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“…The second new outcome was disease-specific; namely that living with dementia and diabetes increased the risk for severe hypoglycemia compared with persons living with diabetes and without dementia (Abbatecola et al , 2015; Prinz et al , 2015). Fourteen new articles (Chang et al , 2012; Chen et al , 2014; Huijts et al , 2013; Llibre et al , 2014; Katsoulis et al , 2014; Lee et al , 2015; Mignardot et al , 2014; Murao et al , 2014; O’Donnell et al , 2012; Park et al , 2016; Sanyal et al , 2014; Warchol-Celinska et al , 2015; van Asch et al , 2013) fell into existing chronic condition-outcome pairings and did not change the quality or strength of the evidence, and four articles (Hawkins et al , 2012; Jacobs et al , 2012; Hajduk et al , 2013; Provencher et al , 2015) were found in separate areas where there was previously no evidence.…”

Section: Resultsmentioning

confidence: 99%

Dementia and co‐occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?

Snowden

Steinman

Bryant

et al. 2017

Int J Geriat Psychiatry

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Objective The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co-occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality. Methods This systematic literature review searched PubMed databases through 2011 (updated in 2016) using key constructs of older adults, moderate-to-severe cognitive impairment (both diagnosed and undiagnosed dementia), and chronic conditions. Reviewers assessed papers for eligibility and extracted key data from each included manuscript. An independent expert panel rated the strength and quality of evidence and prioritized gaps for future study. Results Four thousand thirty-three articles were identified, of which 147 met criteria for review. We found that moderate-to-severe cognitive impairment increased risks of mortality, was associated with prolonged institutional stays, and decreased function in persons with multiple chronic conditions. There was no relationship between significant cognitive impairment and use of cardiovascular or hypertensive medications for persons with these comorbidities. Prioritized areas for future research include hospitalizations, disease-specific outcomes, diabetes, chronic pain, cardiovascular disease, depression, falls, stroke, and multiple chronic conditions. Conclusions This review summarizes that living with significant cognitive impairment or dementia negatively impacts mortality, institutionalization, and functional outcomes for people living with multiple chronic conditions. Our findings suggest that chronic-disease management interventions will need to address co-occurring cognitive impairment.

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Section: Resultsmentioning

confidence: 99%

Dementia and co‐occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?

Snowden

Steinman

Bryant

et al. 2017

Int J Geriat Psychiatry

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“…13,15 These studies, however, were limited by the absence of suitable comparison groups and by retrospective reports of pre-illness function. In contrast, our study included a matched comparison group of older persons with no ED visit and included prospective reports of pre-illness function.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons

Nagurney

Fleischman

Han

et al. 2017

Annals of Emergency Medicine

111

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Objective Among older persons, disability and functional decline are associated with increased mortality, institutionalization, and costs. To determine whether illnesses and injuries leading to an emergency department (ED) visit but not hospitalization are associated with functional decline among community-living older persons. Methods From a cohort of 754 community-living older persons who have been followed with monthly interviews for up to 14 years, we matched 813 ED visits without hospitalization (ED-only) to 813 observations without an ED visit or hospitalization (control). We compared the course of disability over the following 6 months between the 2 matched groups. To establish a frame of reference, we also compared the ED-only group with an unmatched group who were hospitalized after an ED visit (ED-hospitalized). Disability scores (range: 0 [lowest] to 13 [highest]) were compared using generalized linear models adjusted for relevant covariates. Admission to a nursing home and mortality were evaluated as secondary outcomes. Results The ED-only and control groups were well matched. For both groups, the mean age was 83.6 years, and 69% were female. The baseline disability scores were 3.4 and 3.6 in the ED-only and control group, respectively. Over the 6-month follow-up period, the ED-only group had significantly higher disability scores than the control group, with an adjusted risk ratio (RR) of 1.14 (95%CI, 1.09–1.19). Compared with participants in the ED-only group, those who were hospitalized after an ED visit had disability scores that were significantly higher (RR 1.17, 95%CI, 1.12–1.22). Both nursing home admissions (HR 3.11, 95%CI, 2.05–4.72) and mortality (HR 1.93, 95%CI 1.07–3.49) were also higher in the ED-only group versus control group over the 6-month follow-up period. Conclusions Although not as debilitating as an acute hospitalization, illnesses and injuries leading to an ED visit without hospitalization were associated with a clinically meaningful decline in functional status over the following 6 months, suggesting that the period after an ED visit represents a vulnerable time for community-living older persons.

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“…24 Using similar inclusion criteria, Provencher et al demonstrated that the risk of functional decline at 3 and 6 months after an emergency department visit was significantly greater for frail participants with cognitive impairment than non-frail participants without cognitive impairment. 25 Shapiro and colleagues demonstrated that 3 months after an emergency department visit for a minor traumatic injury, 7% and 23% of patients had a decline in basic and instrumental activities of daily living, respectively. 26 …”

Section: Discussionmentioning

confidence: 99%

Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults

Brown

Kennedy

et al. 2016

The American Journal of Medicine

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Purpose To assess effects of emergency department visits on mobility as measured by Life-Space Assessment (LSA) scores and to compare life-space trajectories associated with emergency department visit only, hospitalization, and no event. Methods 410 community-dwelling adults age ≥75 who were living in the community, able to communicate by telephone, could schedule an in-home interview, and answer questions independently were followed from June 2010-August 2014. In-home baseline and monthly telephone follow-up interviews collected data on LSA scores, emergency department use, and hospitalizations. Life-space is measured using a validated patient-reported tool reflecting community mobility and quality of life. Trajectories of LSA before and after an emergency department visit or hospitalization were compared to no event occurrence. Results Mean age was 81.7 (SD 4.8) years; 57% were female and 35% were African American. During three years of follow-up, 83 persons (20%) had an emergency department visit without subsequent hospitalization and 164 (40%) were hospitalized. While baseline LSA scores were similar, in the month following an emergency department visit, adjusted LSA scores decreased by 6.1 points (p=.01) in comparison to hospitalized participants who experienced an average 18.0 points decrease (p<.0001). Neither those with an emergency department visit only nor hospitalization recovered to their prior level of community mobility. Moreover, those with an emergency department visit showed no significant improvement in LSA scores up to 1 year later. Conclusions Older adults who experienced an emergency department visit or hospitalization had an associated decrease in community mobility without significant recovery.

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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?

Abstract: Easy-to-administer frailty and cognitive screening tools should be included in ED assessments to identify independent older adults at high risk of functional decline after minor injury so that appropriate services may be provided to prevent deterioration in ADLs.

Cited by 63 publications

References 42 publications

Dementia and co‐occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?

Dementia and co‐occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?

Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons

Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults

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