Connecting Emergency Departments with Community services to prevent mobility losses in injured pre-frail & frail Seniors (CEDeComS)
Main objectives of this interventional trial include: implementing a new intervention toolbox, comparing the effectiveness of it versus usual discharge on reducing functional and mobility decline and frailty in previously independent seniors in the ED with minor injuries and evaluating post-ED health resource use and cost-effectiveness.
About the Project
Each year in Canada, nearly 400,000 community-dwelling seniors sustain injuries that are not fatal but that limit their mobility and activities of daily living. The vast majority of them seek medical care in Emergency Departments (EDs) and two-thirds are discharged back home with various minor injuries. Evidence generated by a multi-centered collaborative Canadian Emergency Team Initiative (CETI) has shown that these minor injuries can trigger a downward spiral of functional decline in 16% of seniors who are still independent at the time of their injury. Moreover, these injuries unmask early signs of physical and cognitive impairments as well as a pre-frail or frail status.
As there are no ED management guidelines designed to prevent these pre-frail/frail injured seniors from losing their mobility & function, their functional status typically deteriorates within six months post-ED discharge. This is unfortunate as there is compelling evidence of the effectiveness of community-based mobility interventions in limiting frailty & improving function. The latter include effective community-based mobility interventions (fall prevention & exercise programs) that are available across all Canadian communities.
In that context, screening seniors at risk of functional decline after a minor injury in EDs is crucial for effective interventions to be implemented. We thus propose a new CEDeComS intervention toolbox that combines CETI-CDR (a Clinical Decision Rule we have validated) screening with rapid linkage to mobility programs in the community, directly from the ED.
Marcel Émond, MD, MSc — Université Laval
Mylène Aubertin-Leheudre, PhD — Université du Québec à Montreal
Luc Bissonnette, PhD, BA, MA — Université Laval
Raoul Daoust, MD, CSPQ, MSc — Hôpital Sacré-Coeur de Montréal
Eddy Lang, MD — University of Calgary
Jacques Lee, MD, MSc, FRCPC — Sunnybrook Research Institute
Jeffrey Perry, MD, MSc — Ottawa Hospital Research Institute
Brian Rowe, MD, MSc — University of Alberta
Marie-Josée Sirois, OT, PhD — Université Laval/CHU de Québec
Andrew Costa, PhD, BSc — McMaster University
Anik Giguère, PhD — Université Laval
Barbara Liu, MD — Sunnybrook Health Sciences Centre
Don Melady, MD, MSc — Mount Sinai Hospital
Nancy Salback, PT, PhD — University of Toronto
Audrey-Anne Turcotte-Brousseau, MD, MSc — Mount Sinai Hospital
Project Contact: Marcel Émond — firstname.lastname@example.org