Mise en place de l'équipe d'intervention gériatrique et de l'évaluation gériatrique aux urgences de l'hôpital Henri-Mondor

Roussel-Laudrin, S.; Paillaud, Éléna; Alonso, Esteban; Caillet, Philippe; Herbaud, Stéphane; Merlier, Isabelle; Lejonc, J. L.

doi:10.1016/j.revmed.2005.03.004

Cited by 18 publications

(13 citation statements)

References 19 publications

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“…We attribute this to a relatively younger population (65 years and above) and to an underreported number of falls. 12;13 The pharmacological groups most frequently causing an ADE in our study (diuretics, coumarins, NSAIDs and platelet aggregation inhibitors) correspond to findings in literature. 24–26 Preventative measures should be focused on these high-risk groups.…”

Section: Discussionsupporting

confidence: 86%

Association between Acute Geriatric Syndromes and Medication-Related Hospital Admissions

et al. 2012

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Background Elderly patients are at a four-fold higher risk of adverse drug events (ADEs) and drug related hospitalization. Hospitalization of an elderly patient is often preceded by geriatric syndromes, like falls or delirium. Objectives The primary aim of this study is to investigate whether geriatric syndromes were associated with ADEs in acutely admitted elderly patients. Methods Consecutive medical patients, aged 65 years or more, and were acutely admitted, were enrolled. An initial multidisciplinary evaluation was completed and baseline characteristics were collected. A fall before admission was retrieved from medical charts. Delirium was determined by the Confusion Assessment Method. Results A total of 641 patients were included. Over 25% had an ADE present at admission, 26% presented with delirium and 12% with a fall. Delirium was associated with the use of antidepressants, antipsychotics, and antiepileptics. In all ADEs (N=167), ADE was associated with a fall, with NSAIDs or diuretics, but not with pre-existing functioning, delirium or older age. For ADEs involving psychoactive medication (N=35), an association was found between delirium, fall, opioids and antipsychotics in bivariate analyses. A fall just before hospitalization (OR 3.69 [95% CI 1.41–9.67]), antipsychotics (OR 3.70 [95% CI 1.19–11.60]) and opioids (OR 14.57 [95% CI 2.02–105.30]) remained independently associated with an ADE involving psychoactive medication. Conclusion This prospective study demonstrated that in a cohort of elderly hospital patients a fall before admission and prevalent delirium are associated with several pharmacological groups and/or with ADE-related hospital admission.

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Section: Discussionsupporting

confidence: 86%

Association between Acute Geriatric Syndromes and Medication-Related Hospital Admissions

et al. 2012

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“…In the elderly, physical examination and history-taking are time-consuming and laboratory values may be unreliable [2][3][4][8][9][10][11][12][13][14]. Moreover, many emergency medicine physicians are uncomfortable with physical examinations of the elderly [24], and the ED literature promotes early, liberal use of imaging.…”

Section: Discussionmentioning

confidence: 99%

“…The ability to accurately and effectively determine the cause of abdominal pain decreases with advancing patient age [2][3][4]. Because elderly patients require more time and resources, they often have prolonged ED visits, longer wait times before seeing a physician and undergo additional laboratory testing [5][6][7].…”

mentioning

confidence: 99%

Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain

2015

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“…Although many studies on the ISAR screening were performed in patients aged 65 or older [8,11,12,14,19], there are also studies showing that the ISAR prediction is better in older patients with a cut-off age of 70 and older [7,20]. Furthermore, there are studies performing the ISAR screening on patients aged 75 and older [21]. Due to these opposed data on the cut-off of age in the ISAR screening, we and the geriatricians involved decided by mutual agreement to use the ISAR screening in ED patients aged 70 and older.…”

Section: Methodsmentioning

confidence: 99%

Prediction of Emergency Department Re-Visits in Older Patients by the Identification of Senior at Risk (ISAR) Screening

Slankamenac¹,

Haberkorn²,

Meyer³

et al. 2018

Geriatrics

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Abstract:The "Identification of Seniors at Risk" (ISAR) screening is a tool to identify seniors at risk of adverse outcomes. We investigated whether seniors with a positive ISAR screening have an increased risk of Emergency Department (ED) re-visits and health-service costs. In a pilot project, we enrolled 96 ED patients (≥70 years) who received an ISAR screening in the ED. We compared the rate of ED re-visits and in-hospital costs between ISAR positive (≥2 pts) and ISAR negative (<2 pts) patients. In some patients, a geriatrician performed a single Geriatric Consultation (GC) during the ED stay to assess older patients' needs.32% of the study population had an unplanned ED re-visit (31 of 96). Fifty patients were ISAR positive (52%) and showed an increased risk of ED re-visits compared with ISAR negative patients (dds ratio (OR) 6.8, 95% confidence interval (CI) 2.2-21.0, p = 0.001). The positive ISAR screening tool fairly predicted ED re-visits in seniors (area under the curve (AUC) 0.711). A single GC during the ED stay did not reduce the risk of unplanned ED re-visits in ISAR positive patients (p = 0.80) ISAR positive patients with GC did not have higher in-hospital costs than ISAR negative patients without GC. Based on these findings, we aim to establish a comprehensive outpatient geriatric assessment program to identify relevant risk factors for ED re-visits and to recommend preventive strategies in ISAR positive ED seniors.

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Mise en place de l'équipe d'intervention gériatrique et de l'évaluation gériatrique aux urgences de l'hôpital Henri-Mondor

Cited by 18 publications

References 19 publications

Association between Acute Geriatric Syndromes and Medication-Related Hospital Admissions

Association between Acute Geriatric Syndromes and Medication-Related Hospital Admissions

Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain

Prediction of Emergency Department Re-Visits in Older Patients by the Identification of Senior at Risk (ISAR) Screening

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