In Canada, around 400,000 independent-living seniors/year sustain injuries that limit their functional mobility. Around 65% of them seek care in Emergency Departments (EDs), 70% of whom are discharged home (CIHI, 2010). The Canadian Emergency and Trauma Initiative in elders (CETIe) has confirmed that minor injuries can trigger a downward spiral of functional decline in 15-18% of previously independent seniors 6 months post-injury, unmasking an undetected early prefrail/frail status. In the current context of resources limitations, specific ED and post-ED community interventions to prevent frailty and functional decline must focus on moderate and high-risk community-dwellers discharged from EDs. In a national meeting of clinicians, researchers and seniors’ care managers; our group identified a gap in knowledge for evidence-based transition of care interventions for these seniors (CIHR, 2014). Comprehensive knowledge is needed about how/where to orient the prefrail and frail seniors sustaining an injury or a fall are identified in the ED. Our main objective was to collect evidence-based information pertaining to this subject in order to help clinicians, patients, seniors’ care managers and researchers know where to orient these patients. Method: we completed a scoping review to examine published scientific and grey literature available on relevant interventions. We summarized all evidence-based ED and post-ED community transition services that can help restore functional abilities and prevent frailty in seniors. Specifically, we 1) identified community services aiming to help maintain/restore the seniors’ previous state of independence; 2) created a repertory of potential post-ED/community services to help pre-frail/frail independent elders with minor injuries or falls. The results of this review will be used to create toolboxes to help ED professionals better manage these seniors by identifying the optimal post-ED community services where to refer at risk seniors to. The toolboxes will be implemented and tested.
Dr. Marcel Emond, MD, MSc, FRCP(C) is an Emergency Physician at the Centre Hospitalier Universitaire (CHU) de Québec and Associate Professor in the Department of Family and Emergency Medicine at Laval University. His research interests include bedside management avenues for the elders in acute care setting. Over the last 10 years, he co-led the CIHR-funded Canadian Emergency and Trauma initiative in elders (CETIe), a multidisciplinary team focusing on independent/pre-frail geriatric population treated in Canadian emergency departments. He’s an active member of the Réseau Québécois de Recherche sur le Vieillissement (RQRV). Since 2016, Dr Émond is a funded senior clinician-scientist by the Fonds Québécois de la Recherche en Santé (FQRS). Since 2013, he works actively to establish the Network of Canada Emergency Medicine Research (NCER).
Pr. Marie-Josée, PhD is an Associate Professor in the Department of Rehabilitation in the Faculty of Medicine at Laval University and researcher at the Centre d’Excellence sur le Vieillissement de Québec. She has co-lead the creation and work of the CIHR-funded Canadian Emergency and Trauma Initiative in elders (CETIe), a multicenter interdisciplinary team studying the consequences of trauma in seniors through large prospective cohorts. Based on a combined focus on identifying the multidimensional determinants of post-injury function in seniors, and on implementing new knowledge in clinical practice, the CETIe aims to improve the acute care and management of this population. Pr Sirois specializes in the assessment and management of frailty in seniors with injuries. She currently works on innovative solutions to improve care transitions between Emergency Departments and community settings in order to prevent functional losses in pre-frail/frail injured seniors. She is a member of the Réseau Québécois de Recherche sur le Vieillissement (RQRV).