Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-13T06:44:22.275Z Has data issue: false hasContentIssue false

Preparing the emergency departments for the “Silver Tsunami”

Published online by Cambridge University Press:  22 January 2020

Marcel Émond*
Affiliation:
Faculté de médicine, Département de médicine familiale et de médicine d'urgence, Université Laval, Laval, QC
*
Correspondence to: Dr. Marcel Émond, Université Laval, 1401, 18e rue, Québec, QC G1J 1Z4; Email: [email protected]

Abstract

Type
Commentary
Copyright
Copyright © Canadian Association of Emergency Physicians 2020

INTRODUCTION

Over the next decades, the demographic trends will fundamentally change the makeup of the population served by Canadian emergency departments (EDs). By 2031, the proportion of adults aged over 65 will nearly double,Reference Heffler, Levitt and Smith1 and this group could represent more than a quarter of the Canadian population by 2036.2 Older adults already represent a high proportion of ED patients3,Reference McCaig and Burt4 and have already been identified as disproportionate users of ED resources.Reference Legramante, Morciano and Lucaroni5 Considering that access to primary care has been reported to be difficult for 25% of Canadians,Reference Desai, Lentzner and Weeks6 it is therefore likely that the number of ED consultations will increase with their growing number. Undeniably, the ‘‘Silver Tsunami’’ will greatly impact the urgent care provided to Canadian seniors by ED professionals. It is therefore of utmost importance to evaluate, prepare, and engage in delivering high quality of care to this growing population.

Over the past decade, several health authorities have developed general guidelines to adapt acute older patients care. For example, in 2010, the Ministère de la Santé et des Services Sociaux du Québec launched the approche adaptée à la personne âgée en milieu hospitalier, which aimed to improve healthcare for patients ages 65 and over.7 In the same year, Toronto's Mount Sinai Hospital launched its Acute Care for Elders Strategy,Reference Sinha, Bennett and Ramsden8 which also had the same objective. In 2014, American Geriatric ED guidelines9 were published and endorsed by the Canadian Association of Emergency Physicians, although these broad guidelines were mostly aimed at ED inpatient care and recommended no specific tools.10

Many published studies suggest that even though tools and models have been tested and are available for older patient care, there is still an important gap for their adaptation, implementation, and actual use in EDs.Reference Platts-Mills, Owens and McBride11, Reference Asomaning and Loftus12 This issue of CJEM presents two articles exploring geriatric-friendly ED tools. Following the adaptation of the Canadian Triage and Acuity Scale, which now includes a senior-frailty modifier, Mowbray et al. aimed to investigate the relationship between triage acuity and frailty.Reference Mowbray, Brousseau, Mercier, Melady, Émond and Costa13 The authors found no direct association between ED triage and older patients’ frailty status. This could be explained by the fact that frailty is a fairly new concept for the ED professionals and may be difficult to conceptualize in a time-pressure environment. Frail, older adults are at an increased risk for adverse outcomes during and after the ED visit.Reference Brousseau, Dent and Hubbard14 However, even though ED triage is a cornerstone of our Canadian acute care system, senior-friendly triage may not be the only window of opportunity to identify pre-frail or frail older adults at risk of complications in the ED or at discharge.

ED tailored geriatric assessment skills and clinical tools could help orient older patient care. In Afilalo et al., two specific tools were evaluated to predict potential functional decline or return to the ED after discharge: gait speed and grip strength.Reference Afilalo, Mottillo, Xue, Colacone, Morais, Delaney and Afilalo15 Their results showed that assessing patient walk in a structured 5-m gait speed test can predict a post-ED discharge adverse event, such as functional decline. However, their grip strength results showed no association with functional decline. Other walk tests, such as the Timed Up and Go, have showed similar results regarding the association between walk speed and adverse event,Reference Eagles, Perry and Sirois16 leading to believe that mobility assessment should therefore be an important aspect of senior-friendly ED care, and that future research should focus on the continuity of care in frail elders at discharge.

It is without any doubt that all health professionals caring for older patients either before, in, or after the ED will need to rapidly adapt their practice in order to provide high-quality care to meet the more complex needs of this growing population.

Competing interests

None declared.

References

REFERENCES

1.Heffler, S, Levitt, K, Smith, S, et al. Health spending growth up in 1999; faster growth expected in the future. Health Affairs 1999;20(2):193203.CrossRefGoogle Scholar
2.Statistiques Canada. Estimations démographiques annuelles: Canada, provinces et territoires; 2012. Available at: https://www.150.statcan.gc.ca/n1/fr/pub/91-215-x/91-215-x2012000-fra.pdf?st=-pRICfIdDate (accessed December 3, 2019).Google Scholar
3.Le commissaire à la santé et au bien-être., Les urgences au Québec: Évolution de 2003–2004 à 2012–2013, B.e.A.n.d. Québec, Editor. 2014, Gouvernement du Québec. Available at: https://www.csbe.gouv.qc.ca/fileadmin/www/2014/Urgences/CSBE_Rapport_Urgences_2014.pdf (accessed December 3, 2019).Google Scholar
4.McCaig, LF, Burt, CW.National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary. Adv Data 2004;340:134.Google Scholar
5.Legramante, JM, Morciano, L, Lucaroni, F, et al. Frequent use of emergency departments by the elderly population when continuing care is not well established. PLoS One 2016;11(12):e0165939.CrossRefGoogle Scholar
6.Desai, MM, Lentzner, HR, Weeks, JD.Unmet need for personal assistance with activities of daily living among older adults. Gerontologist 2001;41(1):82–8.CrossRefGoogle ScholarPubMed
7.Ministère de la santé et des services sociaux. Approche adaptée à la personne âgée en milieu hospitalier - Cadre de référence; 2011. Available at: https://publications.msss.gouv.qc.ca/msss/document-000697/ (accessed December 3, 2019).Google Scholar
8.Sinha, SK, Bennett, J, Ramsden, R, et al. Delivering improved patient and system outcomes for hospitalized older adults through an Acute Care for Elders Strategy. Healthc Manage Forum 2018;31(4):126–32.CrossRefGoogle ScholarPubMed
9.American College of Emergency Physicians; American Geriatrics Society; Emergency Nurses Association; Society for Academic Emergency Medicine; Geriatric Emergency Department Guidelines Task Force. Geriatric emergency department guidelines. Ann Emerg Med 2014;63(5):e725.CrossRefGoogle Scholar
10.Canadian Association of Emergency Physicians (CAEP). CAEP endorsement process; 2019. Available at: https://caep.ca/endorsements/ (accessed December 3, 2019).Google Scholar
11.Platts-Mills, TF, Owens, ST, McBride, JM.A modern-day purgatory: older emergency department patients with non-operative injuries. J Am Geriatr Soc 2014;62(3):525–8.CrossRefGoogle Scholar
12.Asomaning, N, Loftus, C.Identification of seniors at risk (ISAR) screening tool in the emergency department: implementation using the plan-do-study-act model and validation results. J Emerg Nurs 2014;40(4):357–64.e1.CrossRefGoogle ScholarPubMed
13.Mowbray, F, Brousseau, A-A, Mercier, E, Melady, D, Émond, M, Costa, AP. Examining the relationship between triage acuity and frailty to inform the care of older emergency department patients: Findings from a large Canadian multisite cohort study. CJEM 2020;22(1):7481.Google Scholar
14.Brousseau, A-A, Dent, E, Hubbard, R, et al. Identification of older adults with frailty in the emergency department using a frailty index: results from a multinational study. Age Aging 2017;47(2):242–8.CrossRefGoogle Scholar
15.Afilalo, J, Mottillo, S, Xue, X, Colacone, A, Morais, JA, Delaney, JS, Afilalo, M. Frailty and adverse outcomes in older adults being discharged from the emergency department: A prospective cohort study. CJEM 2020;22(1):6573.Google Scholar
16.Eagles, D, Perry, JJ, Sirois, MJ, et al. Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor traumadagger. Age Aging 2017;46(2):214–8.Google ScholarPubMed