Clinical trial NCT01706133: An Intervention for Elderly in Emergency Services
Official title: Elderly in Emergency Services: Effectiveness of an Intervention to Improve Health Outcomes
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Stroke
Ischemic Attack
Diabetes Mellitus
Hypertension
Fragility
Keywords: Frailty, emergency services, elderly
Lead sponsor: Coordinación de Investigación en Salud, Mexico
Sponsor class: OTHER_GOV
Collaborators: name: Instituto Mexicano del Seguro Social
First posted: 2012-10-15
Enrollment: 1400
Sex: ALL
Minimum age (years): 70
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: -Can a scheme based on inter geriatricians visiting nurse consultants and reduce negative impacts on the health of elderly over 70 years ?

Detailed description: - Usual care as the comparison group

Usual care or standard refers to those processes or services that the elderly claimant receives the IMSS services network, after the acute phase of their illness has been stabilized and is defined that can be discharged from the emergency department, following clinical and therapeutic recommendations for improving their health.

* Elders risk population for emergency

The aging population brings a major change in health conditions and social conditions around the elderly, the analysis of the elderly population is considered according to functionality and risks of old age, when it comes to care services emergency, care becomes more critical as the elderly are older, have been identified adults of 70 and over as more vulnerable to health services, especially for the emergency services as they do not exhibit classic patterns to acute events of prevalent diseases.

* Functionality and dependence

The commitment of the functionality in adults older than 65 may be present in 5% of cases, while in over 70 years this figure rises to 50% or more. Functional impairment may be a "marker" of the effect of systemic disease on the patient and is also an indicator of severity of disease because it measures the ability of independence

The accumulation of normal aging characteristics define a threshold, which once pierced, tends to increase the propensity for loss of functional abilities due to aging. However, not everyone ages the same way, since factors such as inherited genetic capital, especially the accumulation of risks associated with lifestyle and work activities, and the opportunity to identify the disease in its period latency coupled with the accessibility and use of health services, can delay or exacerbate the loss of functionality and increase the dependency of the elderly.

* Quality of life of older

Frailty in the elderly is a state of increased susceptibility due to less booking multiple physiological systems resulting in lower resilience, negative energy balance, sarcopenia, decreased strength and reduced exercise tolerance. Frailty is associated with adverse health outcomes such as institutionalization, falls, reduced performance status and increased mortality.

Eligibility criteria: Inclusion Criteria:

* Adults 70 and over.
* Both sexes
* Affiliation force in the IMSS
* Attending spontaneously or referred to the emergency department of hospitals in the study.
* Agree to participate in the study phase in observational or intervention by signed written informed consent

Exclusion Criteria:

1. Adults 70 and older whose income is service by:

   a. A very serious acute condition with imminent risk to life and requires immediate emergency care, cataloged by the Triage system marked by the IMSS as Red or (state the patient's functional impairment characterized by high and low, with imminent risk life or the integrity and function of some of their organs and requires immediate medical attention since his arrival to the emergency room) or require emergency care (patient condition characterized by acute and severe functional impairment, life-threatening or the integrity and function of some of their organs and requires medical attention within the next 10 minutes after arrival at the emergency department).
   * An automobile accident
   * Burn-grade II or III
   * Partial or total unconsciousness
   * Severe cognitive impairment
2. Individuals who do not agree to participate in the study

Primary outcomes:
measure: Change in hand grip strength (HS) as a physical performance test
timeFrame: Basal and Six months
Secondary outcomes:
measure: Evaluation of individual and institutional impact
timeFrame: Six Months
Other outcomes:
measure: Quantify hospital readmissions
timeFrame: One Year
Locations:
city: Mexico
country: Mexico
facility: XXI Century National Medical
state: Distrito Federal
Study officials:
affiliation: Epidemiological Research Unit and Health Services. XXI Century National Medical Center
name: Carmen García-Peña, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Epidemiological Research Unit and Health Services. XXI Century National Medical Center
name: Sergio Sánchez García, PhD
role: STUDY_CHAIR
affiliation: Epidemiological Research Unit and Health Services. XXI Century National Medical Center
name: Teresa Juarez Cedillo, PhD
role: STUDY_CHAIR
affiliation: Emergency Service. General Hospital Zone No.2
name: Rogelio Moncada Tobias, Doctor
role: STUDY_CHAIR
affiliation: Internal Medicine. General Hospital Zone No. 2
name: Nubia Franco Alvarez, Doctor
role: STUDY_CHAIR
affiliation: Department of Nephrology. Regional General Hospital No. 1
name: José García González, Master
role: STUDY_CHAIR
affiliation: Institute of Geriatrics
name: Ulises Pérez Zepeda, Master
role: STUDY_CHAIR
affiliation: National Institute of Psychiatry
name: Leslie Viridiana Robles Jiménez, Doctor
role: STUDY_CHAIR
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