Screening for social needs in accident and emergency departments.

Abstract

It is estimated that 10% of patients attending accident and emergency (A&E) departments are elderly and that in some cases the department is used as an extension of a primary care facility.1 In a recent report we showed that even 'minor fractures' significantly impaired elderly patients' ability to live independently and that more than 50% of such patients discharged from A&E had functional scores compatible with moderate to severe functional impairement.2 While many of the patients acquired help from family, friends and neighbours, a proportion required additional help or were totally dependent on statutory help. This 'at risk' group needs to be identified before discharge from A&E.In a survey to establish the extent of social screening in A&E; 105 patients aged 70 years or over, who had sustained minor fractures, had not been admitted to hospital, but were attending a fracture clinic were interviewed by the author during their first fracture clinic visit. The interviews occurred mostly within 7 days of sustaining a fracture -84% were interviewed within 5 days of their injury. The patients were asked whether enquiries had been made concerning their social needs, who made such enquiries, and if they knew how to request statutory social services in the community.We found that in this cohort of 105 patients 71 (68%) had not been asked whether they could cope with activities of daily living once discharged. Of the remaining 34 (32%) who remembered being asked: 22 had been asked by a nurse in A&E; 17 by an A&E doctor; nine by a general practitioner; and three had been asked by other persons, e.g. physiotherapist.Two patients had been interviewed by a medical social worker before leaving the A&E department. Of patients, 42 (40%) did not know how they would go about requesting statutory help in the community and 61 (58%) were knowledgeable about community services.These results mirror the findings of Currie et al.3 who found scanty documentation of social and functional screening after scrutiny of A&E records. The problem is further amplified by the fact that 40% of the elderly patients in this study were not aware of how to acquire statutory help in the community. While the A&E doctor may be well-placed to assess the social and functional needs of the patients, in a busy A&E department, time is at a premium. Additionally, functional assessment requires special knowledge and skills which are not taught routinely to doctors. The importance of social management in elderly people cannot be over-emphasized and it is imperative that all who treat them be made aware of this.To alleviate this problem, some A&E departments have adjacent short-stay wards and cover from a social worker. Others have an

Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions

“…[46][47][48][49] However, despite their importance, functional dependence, psychosocial concerns, and geriatric conditions are often underdetected, poorly documented, and inadequately addressed during ED encounters with older patients. 25,31,35,40,[50][51][52][53][54][55] The identification of high-risk elderly patients is the first step in targeting appropriate interventions to promote positive patient outcomes. 38 An increased awareness of the complexity of care needs of older emergency patients has led to the development of a growing number of hospital-and community-based geriatric screening and intervention programs targeting this population.…”

An Audit of Referrals to Occupational Therapy for Older Adults attending an Accident and Emergency Department

“…Bridges et al (2000) suggested that A&E departments can fail to meet the special needs of these patients because of the inadequate knowledge of staff (Brymer et al 1996). Nankhonya (1994) found that 68% of 105 older patients attending A&E departments, who were over 70 years and had sustained a fracture, were not asked if they could cope with activities of daily living. The Audit Commission (1996) discovered that 30% of A&E departments were discharging frail elderly patients with no follow-up care.…”

Functional Assessment of Older Adults in an Emergency Department

“…Elderly persons comprise 10 to 15% of emergency department visits and are five times more likely to be admitted to hospital than non-elderly patients (Meyers, 1992;Sanders, 1992;Strange, Chen & Saunders, 1992). Emergency medical staff typically feel less comfortable and less skilled in dealing with elderly persons (Nankhonya, 1994;Sanders, 1992;Sanders & Morley, 1993). Emergency departments may not be meeting the complex medical and psychosocial needs of the older adult.…”