Variations in elderly peoples’ visits to the emergency departments in Iceland: A five-year population study

To access publisher's full text version of this article click on the hyperlink belowINTRODUCTION: Elderly people visiting emergency departments (ED) are a non-homogenous group. Gender and other socio-demographic variations in emergency care might be present. However, gender-specific ED-data is scarce. METHODS: We retrieved retrospective data on all ED-visits, by 67years and older from 2008 to 2012, and calculated incidence of visits applying population registries. The relationship of age-categories, marital status, health and residence with outcomes were analyzed descriptively by Chi-square tests. Regression models were built to analyze gender-specific variations. RESULTS: Of the total ED-visits, 20% were from the elderly population (n=66,141), at a mean 3.1 visits per individual. Men (n=30.269) had higher incidence of visits in all age-categories. They were mostly married (69%) and women widowed (43%), although the incidence of partnered visitors underrepresented population-data while widowed and single living overrepresented. Women had more often co-morbidities, their most common causes of visits were musculoskeletal (20%) and men circulatory causes (14%). Men were more likely to be admitted (OR: 1.23; 95% CI 1.16-1.30) and had more unplanned ED-revisits (HR: 1.20; 95% CI 1.06-1.35) within 30 days. DISCUSSION: Elderly men visiting the ED were more often married than women. Gender differences were found in causes of visits and outcomes. In clinical practice, gender may be considered when identifying risk and planning adequate care related elderly ED-visits.Nursing Association Research fund Landspitali University Hospital Science Fund Icelandic Geriatric Association Research Fun

Hip fractures among older people in Iceland between 2008 and 2012.

To access publisher's full text version of this article click on the hyperlink belowHip fractures are a serious injury especially among older people, mainly caused by falls and women have a higher risk. The authors studied gender differences in hip fractures, marital status, waiting times for surgery and mortality in an older population. Data was obtained for all 67 years and older admitted with hip fractures to an Emergency Department (ED) in Iceland 2008-2012. The associations of covariates with mortality were analyzed using multivariable logistic regression. The study included 1053 patients; covering 80% of hip fractures in Iceland during the study period, 72% were women. Men were more often married (51% vs. 23%) (P < 0.001). Average waiting time was men vs. women 21.5 h/18.9 h (p = 0.003). Mortality within 12 months was men 36% vs. women 21% (Odds Ratio (OR); 2.30, 95% Confidence Interval (CI); 1.66-3.18). Higher mortality rates were observed in older age-groups compared to 67-79 years old, i.e.80-89 years: OR 1.80 (95% CI 1.25-2.60) and 90-109 years: OR 4.52 (95% CI 2.91-7.01). Waiting time was not associated with 12-months mortality risk after adjustment. Although women constitute the majority of elderly with hip fractures, men had higher mortality in our study. Further reserach that examine factors affecting gender difference will likey be of benefit and associated changes to the care already dleivered in the ED may improve mortality.Nursing Association Research fund Landspitali University Hospital Science Fun

Patients in need of comprehensive geriatric assessment: The utility of the InterRAI emergency department screener.

To access publisher's full text version of this article click on the hyperlink belowIntroduction: The interRAI Emergency Department-Screener (ED-screener) is a risk stratification instrument incorporating functional and social aspects to identify older adults in EDs. The aim was to assess the construct validity and utility of the ED-screener in comparison with more established instruments. Methods: The ED-screener, Triage Risk Screening Tool (TRST) and Identification of Seniors at Risk (ISAR) were administered to older ED-patients. Construct validity was assessed by correlation with TRST and ISAR. The ED-screener scores that corresponded to the established cut-offs for ISAR and TRST were assessed with linear regression. The sensitivity and specificity of the ED-screener for mortality at 4-months were calculated. Results: Two hundred patients were included (mean age 78.5 years, 44% male). Majority (85%) lived at home, 43% lived alone and 53% received home care. The scores of 3.02 and 3.01 on ED-screener corresponded to the cut-off score of 2 on the other instruments. The correlation of the ED-screener with ISAR and TRST was 0.56 and 0.41 respectively. A score of 3 on the ED-screener was 100% sensitive and 28% specific for 4-month mortality. Conclusion: These findings provide support for the construct validity of the ED-screener and its ability to predict outcomes in its intended setting. Keywords: Comprehensive geriatric assessment; Emergency department; InterRAI ED-screener; Screening.Landspitali University Hospital Research Fund University of Iceland Research Fun

An Adaptation, Extension and Pre-Testing of an Interactive Decision Aid for Men Diagnosed with Localized Prostate Cancer in Iceland: A Mixed-Method Study.

To access publisher's full text version of this article click on the hyperlink belowIn this study an interactive decision aid (DA) for men diagnosed with localized prostate cancer was adapted, extended and pre-tested. The DA's prototype was based on a literature review and other empirically tested DAs. Semi-structured interviews with 12 men (age 65-80) diagnosed with localized prostate cancer were conducted to get feedback on content, usability, and the DA's layout. The interviews were analyzed using thematic analysis and themes were identified using deductive and inductive coding. Participants found the accessibility of the information and the explicit values clarification tool helpful. Four themes were identified: (1) usability and design, (2) content and knowledge, (3) deciding factors of decision-making, and (4) social support. Participants valued receiving extensive and realistic information on surgery/radiation therapy side effects and getting unbiased presentations of treatment options. Following the thematic analysis, the DA was revised and tested in a survey among 11 newly diagnosed prostate cancer patients (age 60-74). The participants valued the DA and found it helpful when making a treatment decision, and all reported that they would recommend it to others making a prostate cancer treatment decision. The DA is currently being tested in a randomized clinical trial (RCT). This is the first DA developed for prostate cancer patients in Iceland and if the results of the RCT show that it is more effective than standard care in assisting newly diagnosed patients with their treatment decision, the DA can be easily translated and adapted to cultures similar to Iceland such as the Nordic countries. Keywords: decision aid; explicit values clarification; localized prostate cancer; treatment options.Icelandic Center for Research 141490 Research Fund of the Icelandic Cancer Societ