Development of a functional status assessment of seniors visiting emergency department

Veillette, Nathalie; Demers, Louise; Dutil, Élisabeth; McCusker, Jane

doi:10.1016/j.archger.2008.01.009

Cited by 14 publications

(18 citation statements)

References 28 publications

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“…Bissett et al 17 assessed the psychometric properties of the ISAR and TRST, as well as two longer instruments, the Older Adult Resources and Services 96 and the Functional Status Assessment of Seniors in Emergency Departments. 97 They concluded that the shorter instruments were more appropriate for timely screening, whereas the longer instruments provide a more comprehensive understanding of functional performance. They did not quantify prognostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

265

213

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Objectives: A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED-validated screening instruments to distinguish patients more or less likely to experience short-term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death.Methods: A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand-searched relevant specialty society research abstracts. Two physicians independently reviewed all abstracts and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical testtreatment threshold analysis was constructed based on the meta-analytic summary estimate of prognostic accuracy for one outcome.Results: A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post-ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self-rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1-year mortality (LR-= 0.27) and nursing home placement (LR-= 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta-analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR-range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3-month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%.Conclusions: Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the r...

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Carpenter

Shelton

Fowler

et al. 2015

Academic Emergency Medicine

265

213

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“…In order to ensure that all the phases of the eating process is emphasised, identification of all relevant ICF-categories could be carried out for a subsequent item generation. An example of the impact of the ICF in the development of an assessment tool is the Functional Status Assessment of Seniors in Emergency Department (FSAS-ED) [51].…”

Section: Identification Of Assessment Toolsmentioning

confidence: 99%

Measuring elderly dysphagic patients' performance in eating – a review

Hansen¹,

Kjærsgaard²,

Faber³

2011

Disability and Rehabilitation

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“…The evaluator extrapolates from the information in order to qualify the person's activities and participation (23 items, 4-level categorical scale of difficulty), body functions (10 items, 3-level categorical scale of impairment) and environmental factors (7 items, 2-level qualifiers). The content and rating system of the FSAS-ED are summarised in Table I. In previous stages of development, the FSAS-ED's content validity and applicability were considered [18][19][20]. The domains assessed by the tool were validated by cross-checking with locally developed (and unpublished) tools as well as with sections of generic tools currently used for addressing functional status in ED.…”

Section: Introductionmentioning

confidence: 99%

“…For this particular purpose, a new assessment tool based on the International Classification of Functioning, Disability and Health (ICF) [17] has been proposed: the Functional Status Assessment of Seniors in the Emergency Department (FSAS-ED) [18]. This 40-item tool addresses the person's functional status prior to as well as following the decision to consult in ED by way of a semi-structured interview with the subjects and/or with additional informants (proxy, ED staff and medical records) to elicit further information.…”

Section: Introductionmentioning

confidence: 99%

Item analysis of the Functional Status Assessment of Seniors in the Emergency Department

Veillette

Demers

Dutil

et al. 2009

Disability and Rehabilitation

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Development of a functional status assessment of seniors visiting emergency department

Cited by 14 publications

References 28 publications

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Risk Factors and Screening Instruments to Predict Adverse Outcomes for Undifferentiated Older Emergency Department Patients: A Systematic Review and Meta‐analysis

Measuring elderly dysphagic patients' performance in eating – a review

Item analysis of the Functional Status Assessment of Seniors in the Emergency Department

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