Cognitive Impairment in Older Emergency Department Users and Associated Adverse Outcomes

Cognitive Impairment in Older Emergency Department Users and Associated Adverse Outcomes: Results From the ER2 Cohort Study Database

This study examines the prevalence and incidence of older ER users with cognitive impairment (i.e., dementia and/or delirium) using the ER2 item temporal disorientation in older ED users who are participants of the ER2 cohort study database.

Study Overview

• Status: Active, not recruiting
• Conditions: Physical Frailty; Cognitive Frailty; Older Emergency Department Users
• Intervention / Treatment: Other: Observational

Detailed Description

The Emergency Departments (EDs) in North America are under duress because of overcrowding, delays and diversions, which increase to epidemic proportions. The aging of Canadian's population amplifies the magnitude of this situation because older ED users are the fastest increasing group of ED users and they have complex and specific needs.

There are simple interventions with which providers must proceed in order to cure or prevent short-term ED adverse events. Delirium, motor deconditioning, polypharmacy-related adverse drug reactions, and inappropriate home support are the main conditions to target when taking care of older ED users. We previously demonstrated that acting on these conditions may significantly accelerate the discharge and significantly reduce the length of ED and hospital stay. Evidence-based medicine showed that simple and early interventions may prevent delirium (e.g., through hydration, avoiding restraint, mobilizing and satisfying basic needs, time and place reorientation) and motor deconditioning (e.g., through encouraging mobility, up to chair at mealtime during daytime hours, providing appropriate walking aid) in older patients. Medication reconciliation is also an efficient intervention to prevent adverse drug reactions. Furthermore, an early assessment of home support is a crucial step in adjusting services for an early and smooth discharge back home. Based on this evidence, we have modified the 6-item Emergency Room Evaluation and Recommendations (ER2) by adding an interventional component to the assessment portion of the tool. The interventional part depends on the assessment's results and is based on recommendations designed to encourage easy and basic interventions that prevent delirium, motor deconditioning, adverse drug interactions and inappropriate home support. These recommendations are based on answers to the ER2 items

• Study Type: Observational
• Enrollment (Estimated): 4724

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Montréal, Quebec, Canada, H3T 1E2
      • Jewish General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 75 years and older (Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Individuals eligible for this study are the participants in the ER2 study.

Description

Inclusion Criteria:

- An unplanned ED visit and to be on a stretcher

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of hospital stay	The length of hospital stay is defined as the average number of days that patients spend in hospital. It will be used the ER2 tool ( Emergency Room Evaluation and Recommendation) to calculate the length of hospital stay.	12 months
Dementia	The diagnosis of dementia	12 months
Delirium	The diagnosis of delirium	12 months
Length of stay in ED	The length of ED stay is defined as the average number of days that patients spend in the ED. It will use the ER2 tool ( Emergency Room Evaluation and Recommendation) to calculate the length of ED stay.	12 months
Hospital admission rate	The number of individuals admitted to the hospital	12 months

Collaborators and Investigators

• Sponsor: Jewish General Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 17, 2020
• Primary Completion (Actual): February 1, 2022
• Study Completion (Estimated): February 1, 2025

Study Registration Dates

• First Submitted: January 17, 2020
• First Submitted That Met QC Criteria: January 17, 2020
• First Posted (Actual): January 22, 2020

Study Record Updates

• Last Update Posted (Actual): February 23, 2024
• Last Update Submitted That Met QC Criteria: February 22, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Neurocognitive Disorders; Disease Attributes; Cognition Disorders; Emergencies; Cognitive Dysfunction; Frailty
• Other Study ID Numbers: 2020-2184

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No