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Citation
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Rosario BH, Yi-En CS, Barrera VC, Diraviyam B, Low SL, Lien C, Wilkinson SP, Tun MH, Koh XY, Loi FC, Hock AAS. Ann. Acad. Med. Singapore 2023; 52(6): 327-330. |
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Abstract
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Singapore's population is ageing rapidly and by 2030, around 1 in 4 citizens will be aged 65 and above.1 Older adults represent 21-40% of emergency department (ED) users and proportionally are the highest users of ED services.2
One-third of community dwellers over 65 years of age fall each year, and 50% will fall again, with 10% of falls resulting in serious injuries such as hip fractures, head injuries, injury-related disability and death.3 Frailty is common in older adults and can be prevented or at least delayed4 with ED frailty interventions and hospital avoidance.5 This letter describes Singapore's introduction of falls interventions and osteoporosis management in older adults attending an ED short stay unit (SSU) and describes integration of geriatric services in the ED.
The ED SSU is a protocol-led unit, staffed by emergency medicine physicians, with a 23-hour maximum length of stay. The falls protocol (FP) was introduced on 10 March 2019, and operates from Sunday 12pm to Friday 9am, following a service development collaboration between geriatricians and emergency medicine physicians. Inclusion criteria identify older adults with falls and aim to avoid acute hospital admission by undertaking comprehensive geriatric assessments (CGA) in the ED SSU administered by a consultant geriatrician, geriatric resident physician and an ED nurse who has received basic training in geriatric care, called a Geriatric Care Champion. A retrospective review was undertaken after 7 months to assess effectiveness of the FP, and a comparator group (CG) was identified in falls patients admitted to SSU under the Blunt Trauma and Head Injury Protocols at our institution between 1 January 2018 and 31 December 2018. Electronic patient records were reviewed, and data collection included demographics, functional assessments, hospital utilisation and mortality. Falls history and injurious fall defined by the presence of fracture, compliance to bone health recommendations, uptake of bone mineral density (BMD) scan and anti-resorptive treatment were reviewed and assumed compliant if anti-resorptive treatment was commenced following the SSU visit. Rockwood's Clinical Frailty Scale (CFS)6 was calculated from the CGA and/or Occupational Therapy assessments and categorised into: CFS 1-3; CFS 4-5; and CFS 6-9. Ethics review exemption was granted by the SingHealth Centralised Institutional Review Board. Descriptive statistics of demographic and clinical variables were compared between FP group and CG. The categorical outcome measures were analysed using chi-squared or Fisher's Exact test and presented as proportions and percentages. T-test was used for continuous data and presented as means and standard deviations. Data were analysed using Stata version 14 (Stata Corp, College Station, TX, US).
Language: en |