Authors (including presenting author) :
Y. C. Chu, Y. L. Lui, S. M. Go, Y. Y. Lam, Y. N. Ng, Y. H. Ho, K. W. Chan and K. T. Ng
Affiliation :
Queen Elizaberth Hospital, United Christan Hospital, Kwong Wah Hospital
Introduction :
Aging population is an overwhelming demographic challenge worldwide. In 2028, the proportion of Hong Kong elderly citizen who aged more than 65 years old would account for approximately 25% of the total population. Emergency Department (ED) becomes a common place for them to seek health and social care, and thus a golden opportunity to identify those at risk of developing adverse outcomes and meet their specific needs. However, a simple, ready-to-use screening tool is lacking in local EDs. We conducted a prospective cohort study, which used the Identification of Seniors At Risk (ISAR) scale, to identify older people who were at risk of having adverse outcomes. ISAR consists of 6 questions regarding patients’ self care management, recent admission rate, vision, memory and number of medications they are taking. The higher the score, the higher risk the older people have.
Objectives :
To evaluate the predictive validity of the ISAR in Hong Kong population and use ISAR to explore the characteristics of geriatric participants.
Methodology :
We recruited 326 patients (age >=65) from 3 EDs (Kwong Wah Hospital, Queen Elizabeth Hospital and United Christian Hospital). Baseline demographic and clinical data were collected by researchers and the ISAR was administered during patients’ ED stay. Baseline ISAR score, adverse outcomes (ED reattendance and hospital readmission) at 30 and 60 days were evaluated. We defined ISAR score >=2 as positive.
Result & Outcome :
The mean age of these participants was 76.7 (±8.2, p< 0.001). 43.3% of the participants had two to three comorbidities. Most of the participants had no carers (43.6%) or one carer (39.9%). 194 participants (59.5%) were ISAR-positive. They were more likely to be hospitalized when compared with ISAR-negative participants (68% Vs 31.1%)(p< 0.001). At 30-days, 103 participants (31.6%) re-attended to ED, and 64 participants (19.6%) had been admitted. At 60-days, 111 participants (34.0%) re-attended and 69 participants (21.2%) were admitted. The ISAR was able to predict the early ED return (30-days), with ISAR-positive participants having more ED re-attendance (RR = 1.6, 95% CI 1.1-2.3, p = 0.011). The occurrence of ED re-attendance in 60 days was also significant (RR = 1.5, 95% CI 1.1-2.2, p = 0.012). ISAR was able to predict hospital readmission in 30 days (RR = 2.18, 95% CI 1.27 - 3.72, p = 0.005) and in 60 days (RR = 2.25, 95% CI 1.35 - 3.77, p = 0.001). Our study showed ISAR was an effective screening tool for the identification of older people who were at risk of developing adverse health outcomes during their ED visit. ISAR was easy to use and quick. About 60% of the patients being studied were considered as ‘at risk’. The ISAR-positive participants were relatively older, more urgent in their ED visit, required one or more caregivers, had a higher tendency to be admitted, re-attend ED and be readmitted to the hospital more often. The administration of this screening tool in Hong Kong ED is the first step to improve the care in this population
