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.

Project Team

Principal Investigators:

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 —

TG 2015-09-P