Principal Investigator: Marcel Émond, MD, MSc, Centre de Recherche du CHU de Québec- Université Laval

Co-Investigators: Sirois, MJ; Veillette, N; Lee, J; Perry, J; Griffith, L; Verreault R;

Collaborators: Moore, L; Ouellet, MC;  Tourigny, A;  Morin, J; Le Sage, N; Ryan, D; Lavoie, A; Daoust, R; Worster, A; Balion, C; Raina, P; Wilding, L; Naglie, G;  Tarride, JE; Liu, B;

Local research coordinator: Nadine Allain-Boulé

Granting agency: Canadian Institutes of Health Research- CIHR

The Canadian Emergency departments Team Initiative (CETI) aims to optimize mobility and prevent functional decline among independent elders after a minor trauma. Community-dwelling seniors suffer unintentional injuries that lead to medical evaluation in the emergency department (ED). About 80 Canadian seniors per 1000/year are estimated to sustain injuries, that lead to a reduction in mobility.

Recent pilot researches tend to show that whether arising from falls (75%), motor vehicle accident (10%) or other causes, minor injuries are associated with loss of mobility in 15% to 20% of otherwise independent seniors that are evident up to 6 months post-injury.

While around 65% of Canadian community-dwelling injured elders seek medical treatment at emergency departments and the majority of them (60%) are discharged home, there is currently no standard approach to risk assessment for subsequent decline in mobility and function nor to ED and post-ED management of independent elders with minor injuries. This is unfortunate because minor injuries among the well elderly can lead to inhibited physical activity and declining social engagement because of fear of falling and further injury. Thus, a minor injury may be a precursor of functional impairment, and overall reduction in quality of life. Moreover, ED personnel do not seem to accurately identify this risk of functional decline (AUC = 0,55) and consequently, appropriate ED and post-ED management does not appear to be undertaken. This practice gap is unfortunate because the evidence is available on the effectiveness of community-based fall prevention interventions. Furthermore, guidelines are available for the care of seniors who fall and evidence suggests that emergency department interventions can be successfully mobilized to address this growing issue in population health and health system effectiveness.

Our team’s new alliance of multidisciplinary scientists proposes to further study the evolution of mobility loss after minor injuries in independent elders, identify its determinants and means of preventing loss of mobility in this population. Their goals will be achieved by developing tools to help clinicians at different post-injury stages. Clinical decision rule will be created for the ED professionals allowing a better rehabilitation process and allocation of community resources. The team will work together to propose knowledge transfer and interventions in different Canadian health care settings in order to maintain mobility and function after an injury in the senior’s population.