Older adults, often frail, frequently present with poorly-defined symptoms leading to an extensive differential diagnosis. These so called ‘non-specific’ complaints (NSCs), such as: ‘feeling unwell’, ‘feeling fatigued’ or ‘feeling dizzy’, are expressions of an acute medical problem in 50% of the cases
Conditions
Interventions
If feasible, an ED-coach (passive or active form) will be appointed to each participant of the care pathway. The NSC will be evaluated in-depth, the patient will undergo APOP-screening during triage a
Sponsors
Netwerk Acute Zorg Brabant (NAZB)
Eligibility
Inclusion criteria
Inclusion criteria: In order to be eligible to participate in this study, a subject must meet all of the following criteria: - Indicated for admission to hospital, and - Age = 70 years, and - A non-specific main complaint at presentation, such as:–– 1. somatic problems: - weakness: physical weakness in the body limiting the patient to perform daily activities - not feeling well: patients expressing a passive behaviour due to not feeling well physically or mentally - change in nutritional status: an abrupt decline of eating and/or drinking, compared to previous eating habits - unexplained weight loss: an ongoing weight loss or recent weight loss of more than 10% of baseline in the previous month, not related to a modified diet or exercise 2. a higher demand of care: - loss of independency: an abrupt or ongoing decline of being able to perform daily activities independently - a necessity for a change in the living situation, due to a higher demand of care - a necessity for 24-7 care, not indicated previously 3. cognitive problems: - disorientation: inability to recall current date, name or current environment - changes in behaviour: unexplained agitation, abrupt changes in behaviour - cognitive decline: abrupt decline in cognitive performances 4. functional status: - loss of mobility: change in functional status leading to limited mobility 5. unexplained falls: a fall not related to extrinsic factors such as poor lighting, unsafe stairways, and irregular ?oor surfaces or to a precise medical or drug-induced cause
Exclusion criteria
Exclusion criteria: A potential subject who meets any of the following criteria will be excluded from participation in this study: - Specific (main) complaint coupled to a diagnosis (pain, dyspnea, cough, localised weakness, swollen extremity, diarrhea, dysuria, bleeding, syncope, skin lesions, vertigo, palpitations, e.g.) - Age <70 years - Patient refusing data collection or participation in the care pathway
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The primary objectives of the care pathway are to evaluate: -Length of stay at the ED (ED-LOS) -Patient satisfaction on 4 domains 1.relief of symptoms (degree of relief and symptoms, duration until symptom relief, impact on function) 2.understanding the diagnosis and cause of symptoms, understanding prognosis 3.presence and understanding of the diagnostic, therapeutic and follow-up plan 4.reassurance during ED-stay | — |
Secondary
| Measure | Time frame |
|---|---|
| The secondary objectives of the care pathway are to evaluate: - Length of stay at the hospital (HOSP-LOS) - Discharge destination - Medical diagnosis (at admission versus discharge) - Frequency of readmissions / revisits - 30-day mortality - Loss of functional status - Costs-effectiveness of the care pathway | — |
Contacts
Public ContactHarm Haak
Maxima MC
Outcome results
None listed