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.
Older adults often experience adverse health outcomes including malnutrition following discharge from emergency departments (ED). Discharge to community care is a transitionary time where nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways in ED settings.
the aim of this systematic review and meta-analysis was to update and synthesise the totality of research evidence on the effectiveness of acute geriatric unit (AGU) care for older adults admitted to hospital with acute medical complaints.MEDLINE, CINAHL, CENTRAL and Embase databases were systematically searched from 2008 to February 2022. Screening, data extraction and quality grading were undertaken by two reviewers. Only trials with a randomised design comparing AGU care and conventional care units were included. Meta-analyses were performed in Review Manager 5.4 and the Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the certainty of evidence. The primary outcome was incidence of functional decline between baseline 2-week prehospital admission status and discharge and at follow-up.11 trials recruiting 7,496 participants across three countries were included. AGU care resulted in a reduction in functional decline at 6-month follow-up (risk ratio (RR) 0.79, 95% confidence interval (CI) 0.66-0.93; moderate certainty evidence) and an increased probability of living at home at 3-month follow-up (RR 1.06, 95% CI 0.99-1.13; high certainty evidence). AGU care resulted in little or no difference in functional decline at hospital discharge or at 3-month follow-up, length of hospital stay, costs, the probability of living at home at discharge, mortality, hospital readmission, cognitive function or patient satisfaction.AGU care improves clinical and process outcomes for hospitalised older adults with acute medical complaints. Future research should focus on greater inclusion of clinical and patient reported outcome measures.
Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults following presentation to the ED. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED.
Abstract Background Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED. Method Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and grey literature was searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed and an algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied to outcomes. Results Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate. Conclusion Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The evidence for the effectiveness of ED interventions for older adults is limited. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended.
annual age-adjusted breast cancer death rates for women in the United States remained remarkably constant, oscillating around 32 deaths per 100,000 over 60 years.During this long timeframe, the surgical treatment of breast cancer evolved from radical mastectomy with mandatory lymph node dissection to lumpectomy coupled with radiation therapy.With this new paradigm, lymph node dissection was reserved for women with tumor-invaded axillary lymph nodes.Beginning in the 1970s, chemotherapy after surgery (adjuvant) and before surgery (neoadjuvant) was added to surgical treatment.The radical diminution in the scope of breast surgery did not alter the national breast cancer death rate.Doing less surgery was neither harmful nor beneficial to long-term survival from breast cancer.In the 1980s two events changed this static picture: the addition of tamoxifen to adjuvant and neoadjuvant chemotherapy, and the introduction of mammography.Beginning in 1990 annual breast cancer death rates in the United States began to fall, and have continued to fall each year since then.In 2001, the last year of published statistics, the breast cancer death rate was 26 deaths per 100,000.Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography.Abnormal mammograms demand a breast biopsy since only one in five abnormal mammograms is actually a breast cancer.Consequently, widespread adoption of mammography has produced an image-guided breast biopsy industry in the United States.Open, surgical breast biopsy has been replaced with image-guided breast biopsy because improved breast biopsy tools have made image-guided breast biopsy equivalent in accuracy to open, surgical breast biopsy.These tools, in turn, have changed the professional lives of surgeons, pathologists, and mammographers, leading to the development of dedicated breast surgeons, breast pathologists, and interventional breast radiologists. Evaluation of digital mammography: update on the UK position
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