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 willbe 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 willbe 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.
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.
Background: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes 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. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS). Patients and Methods: Older adults presenting to the ED of a university teaching hospital 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. 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 home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive. Results: Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group. Conclusion: ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group. Trial Registration: The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602. Plain Language Summary: Older people need support when they are discharged from the Emergency Department (ED) to their home as a visit to the ED is linked to negative outcomes. This study reports on a trial to reduce negative outcomes in older people discharged from the ED by an assessment in the ED and treatment in the home. Twenty-nine patients attending the ED of University Hospital Limerick were randomly assigned to three groups as follows: One group got the normal care and treatment; Group two received a comprehensive assessment by a dedicated geriatric doctor in the ED and were referred to other health professionals as needed; a third group, called ED PLUS, also received a comprehensive assessment by a dedicated geriatric doctor in the ED and an additional six-week treatment program led by a physiotherapist. The physiotherapist visited the older adult in their own home within twenty-four hours of discharge to start treatment based on what the older adult needed to do to live safely in their own home and again at week four and week six. The same geriatric doctor who saw the older adult in the ED telephoned the older adult in week two to check medications and discussed the case with the physiotherapist. A dietitian and occupational therapist telephoned the older adults to check nutritional intake and if any aids were needed in the home. All older adults in the ED PLUS group had improved quality of their life, improved mobility and did not need to go back to the hospital or ED at six weeks and six months unlike the two other groups. The COVID-19 pandemic affected recruitment, but all ED PLUS patients were extremely satisfied. Keywords: emergencies, recruitment, integrated care, care transitions, public and patient involvement
To co-create expert guidelines for the management of pregnancy, birth, and postpartum recovery in the context of hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD). Scoping Review and Expert Co-creation. United Kingdom, United States of America, Canada, France, Sweden, Luxembourg, Germany, Italy, and the Netherlands. Co-creators (n = 15) included expertise from patients and clinicians from the International Consortium on the Ehlers-Danlos syndromes and Hypermobility Spectrum Disorders, facilitated by the Ehlers-Danlos Society. A scoping review using Embase, Medline, the Cochrane Central Register of Controlled Trials and CINHAL was conducted from May 2022 to September 2023. Articles were included if they reported primary research findings in relation to childbearing with hEDS/HSD, including case reports. No language limitations were placed on our search, and our team had the ability to translate and screen articles retrieved in English, French, Spanish, Italian, Russian, Swedish, Norwegian, Dutch, Danish, German, and Portuguese. The Mixed Methods Appraisal Tool was used to assess bias and quality appraise articles selected. The co-creation of guidelines was based on descriptive evidence synthesis along with practical and clinical experience supported by patient and public involvement activities. Primary research studies (n = 14) and case studies (n = 21) including a total of 1,260,317 participants informed the co-creation of guidelines in four overarching categories: 1) Preconceptual: conception and screening, 2) Antenatal: risk assessment, management of miscarriage and termination of pregnancy, gastrointestinal issues and mobility, 3) Intrapartum: risk assessment, birth choices (mode of birth and intended place of birth), mobility in labor and anesthesia, and 4) Postpartum: wound healing, pelvic health, care of the newborn and infant feeding. Guidelines were also included in relation to pain management, mental health, nutrition and the common co-morbidities of postural orthostatic tachycardia syndrome, other forms of dysautonomia, and mast cell diseases. There is limited high quality evidence available. Individualized strategies are proposed for the management of childbearing people with hEDS/HSD throughout pregnancy, birth, and the postpartum period. A multidisciplinary approach is advised to address frequently seen issues in this population such as tissue fragility, joint hypermobility, and pain, as well as common comorbidities, including dysautonomia and mast cell diseases.
RRH: Rural and Remote Health. Published article number: 8154 - A physiotherapy-led transition to home intervention for older adults following Emergency Department discharge: a pilot feasibility randomised controlled trial
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