Trajectories of Symptoms in Nursing Home Residents After a Transfer to the Emergency Department
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TRAJECTORIES OF SYMPTOMS IN NURSING HOME RESIDENTS AFTER A TRANSFER TO THE EMERGENCY DEPARTMENT V. GUION1, P. DE SOUTO BARRETO2, Y. ROLLAND2 1. UPS/Inserm UMR1027, Toulouse, France; 2. Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), UPS/Inserm UMR1027, Toulouse, France. Corresponding author: Vincent Guion, Gerontopole, 20 rue du Pont Saint-Pierre, Cité de la Santé, CHU de Toulouse, 31059 Toulouse, France, [email protected]
Abstract: Objective: To describe the trajectories of pain, dyspnea, fever, confusion, agitation and fatigue of nursing home residents’ (NHRs) after a transfer to the emergency department (ED). Design: Observational multicenter study. Setting: 17 EDs in France. Participants: 751 NHRs presenting to EDs over four nonconsecutive weeks (one week per season) in 2016. Measurements: Trajectories of symptoms (binary variables) including pain, dyspnea, fever, agitation, confusion and fatigue at four times: before ED transfer, during the transfer, in the ED and after discharge. Results: Group-based multi-trajectory modelling was performed to identify groups of NHRs following similar trajectories of symptoms evolution after a transfer to ED. Five groups were identified. In group 1 (n=190), NHRs presented with confusion and a rising prevalence of fatigue. In group 2 (n=212), NHRs presented with a highly prevalent but declining pain. In group 3 (n=158), NHRs presented with similar peaking pain prevalence, rising confusion and fatigue, and a high but stable agitation prevalence. In group 4 (n=144), NHRs presented with a highly prevalent but declining dyspnea, rising then declining fever, rising confusion, and a high and fluctuating fatigue prevalence. In group 5 (n=47), NHRs presented with a highly prevalent but declining fever, rising then declining dyspnea, stable and high both fatigue and pain prevalence, stable and low prevalence of confusion. Conclusion: Symptom alleviation in NHRs transferred to ED was better achieved in those with pain, fever or dyspnea rather than in those with confusion, agitation and fatigue. NHRs’ resilience through the stress of an ED transfer could be predicted by comorbidity and functional abilities, challenged by acute conditions representing various levels of stress intensity, and evaluated on the course of non-specific symptoms. NHRs’ resilience is key to estimate the appropriateness of an ED transfer and should facilitate advance care planning regarding NHRs’ hospitalizations. Key words: Pain, dyspnea, fever, confusion, agitation, fatigue.
Introduction
discharge back to nursing home, and identify predictive factors of symptomatic outcomes.
Symptom control in nursing home residents (NHRs) can be threatened by the onset of acute illnesses (1). Inadequate symptom control influences emergency departments (ED) transfer decisions, sometimes against advance directives (2) and in dying NHRs (3), while resulting in mixed outcomes in terms of symptom control (4). Predictive data on NHRs’ symptoms trajectories could help decision-makers
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