Care pathway for older adults presenting with non-specific complaints at the emergency department

• Conditions: 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

• Registration Number: NL-OMON26529
• Lead Sponsor: etwerk Acute Zorg Brabant (NAZB)

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Results First Posted: 1900-01-01
• Last Update Posted: 28 February 2024

Recruitment & Eligibility

• Status: Pending
• Sex: Not specified
• Target Recruitment: 466

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

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

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
The primary objectives of the care pathway are to evaluate:<br>-Length of stay at the ED (ED-LOS)<br>-Patient satisfaction on 4 domains <br>1.relief of symptoms (degree of relief and symptoms, duration until symptom relief, impact on function) <br>2.understanding the diagnosis and cause of symptoms, understanding prognosis<br>3.presence and understanding of the diagnostic, therapeutic and follow-up plan<br>4.reassurance during ED-stay<br>

Secondary Outcome Measures

Name	Time	Method
The secondary objectives of the care pathway are to evaluate: <br>-Length of stay at the hospital (HOSP-LOS) <br>-Discharge destination<br>-Medical diagnosis (at admission versus discharge)<br>-Frequency of readmissions / revisits<br>-30-day mortality<br>-Loss of functional status <br>-Costs-effectiveness of the care pathway<br><br>