Frailty assessment of Older Canadians Using Emergency Services with Tablet Technology

(FOCUS –TT)

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Principal investigator: Jacques Lee, MSc, FRCP. Sunnybrook Health Science center, Toronto

Local Investigator: Marcel Émond, Marie-Josée Sirois, Centre de Recherche du CHU de Québec- Université Laval

Co-investigators:  Lee, j; Goldstein, j; Chignell, M; Rockwookd, K; Nolan, M; Tierney, M

Local research coordinator: Valérie Boucher

Granting agency: TVN ( Technology Evaluation in the Elderly Network), which gets funding from the Government of Canada through the program Réseaux des Centres d’Excellence (RCE)

Older Canadians living independently in their homes who need Emergency services, which include ambulance or Paramedic Services and the Emergency Department (ED), have higher rates of mortality and are at increased risk of losing their independence following Emergency care despite receiving more tests and resources compared to younger patients. Recently, the understanding that older patients with frailty are more vulnerable to such adverse outcomes has gained acceptance. Unfortunately, there is no currently accepted method for identifying high risk older adults using Emergency services and a recent systematic review concluded that none of the existing screening tools should be used to guide individual care or health policy.

We hypothesize that patients identified with higher frailty or cognitive impairment by FOCUS tablet technology will have increased rates of functional decline, reduced quality of life and increased use of health care resources.

Objectives: The overall goal of the FOCUS –TT project is to test the real-world implementation of a novel user-friendly, tablet based technology designed to identify high-risk older adults with unrecognized frailty or cognitive impairment. Once identified, these vulnerable older adults will be referred for preventative community-based services to reduce the incidence of complications such as functional decline, loss of independence, and potentially mortality. Specifically, we will:

1) Assess whether use of the Frailty assessment of Older Canadians Using Emergency Services (FOCUS) tablet technology accurately identifies frailty and cognitive impairment among older adults using Emergency Services in 6 acute care settings in 3 provinces.

2) In addition, we will test the real-world implementation of use of the FOCUS tablet-technology to electronically refer patients identified as frail or cognitively impaired to preventative community-based services.

Methods: We propose to conduct a prospective observational study.

Inclusion and Exclusion criteria: We will include older patients who call 911 for paramedic services or who present to an ED. We will exclude patients who:

  1. Have a critical ill patients rendering them unable to communicate or provide consent,
  2. Live in a full care nursing home
  3. Have known severe cognitive impairment (MMSE < 24)
  4. Are visual impairment that makes them unable to use the FOCUS tablet
  5. Have other communication difficulties preventing use of the FOCUS tablet

This research is funded by TVN, which is supported by the Government of Canada through the Networks of Centres of Excellence (NCD) program.

Principal Investigator of the study

Jacques Lee, MSc, FRCP. Sunnybrook Health Science center, Toronto

Principal Investigator CHU de Québec

Marcel Émond M.D. M.Sc. CCMF(EM) FRCPC, Emergency physician, Hôpital de l’Enfant-Jésus, Clinician- Scientist, CHU de Québec

Co-Investigators

Marie-Josée Sirois
Judah Goldstein
Mark Chignell
Kenneth Rockwookd
Mike Nolan
Mary Tierney

Research coordinator (HEJ site): Valérie Boucher