Self-assessment of functional status in older emergency department patients: a cross-over randomized pilot trial

Abstract

Objective

To assess the inter-rater reliability and feasibility of the self-assessed Older Americans Resources and Services scale compared to its administration by a research assistant in older Emergency Department (ED) patients.

Method

This is a planned sub-analysis of a single-center randomized cross-over pilot study. A convenience sample of ED patients aged ≥ 65 was constituted at the CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus) between 2018/05 and 2018/07. Research assistants assessed participants’ functional status using the Older Americans Resources and Services scale and patients self-assessed using a modified Older Americans Resources and Services scale. Test administration order was randomized. The main outcome, inter-rater reliability, was measured using intraclass correlation (ICC). Feasibility was measured using self-assessment completion rate.

Results

67 patients were included and 60 completed self-assessment. Mean age was 74.4 ± 7.6 and 34 (56.7%) participants were women. Mean research assistant-assessed Older Americans Resources and Services scale score was 25.1 ± 3.3, while mean self-assessed Older Americans Resources and Services scale score was 26.4 ± 2.5 [ICC: 0.8 (95% CI: 0.7–0.9)]. Mean activities of daily living scores were 12.5 ± 1.8 for research assistant assessment and 13.5 ± 0.9 for self-assessment [ICC: 0.6 (95% CI: 0.4–0.7)]. Mean instrumental activities of daily living scores were 12.6 ± 1.8 and 12.9 ± 1.8 for research assistant assessment and self-assessment, respectively [ICC: 0.9 (95% CI: 0.8–0.9)].

Conclusion

Our results indicate that self-assessment of functional status by older ED patients is feasible, and good-to-moderate inter-rater reliability results were obtained. A self-assessed score may identify patients in need of further geriatric/functional assessment who may otherwise have been left unscreened.

Résumé

Objectif

Évaluer la fidélité interjuges et la faisabilité pour les patients âgés de s’autoévaluer avec l’outil Older Americans Resources and Services scale au Département d’urgence (DU) comparativement à son administration par un assistant de recherche.

Méthode

Il s'agit d'une sous-analyse planifiée d'une étude pilote croisée randomisée unicentrique. Un échantillon de convenance de patients âgés de ≥ 65 ans consultant au DU du CHU de Québec-Université Laval (Hôpital de l’Enfant-Jésus) entre 2018/05 - 2018/07 a été constitué. Les assistants de recherche ont évalué le statut fonctionnel des participants en utilisant le Older Americans Resources and Services scale et les patients se sont autoévalués en utilisant une version modifiée de cet outil. L'ordre des types d’administration a été randomisé. L’issue principale, la fidélité interjuges, a été mesurée à l'aide de coefficients de corrélation intraclasse (ICC). La faisabilité a été mesurée à l'aide du taux d'achèvement de l'autoévaluation.

Résultats

67 patients ont été inclus dans l’étude principale dont 60 ont complété l'autoévaluation. L'âge moyen était de 74,4 ± 7,6 ans et 34 (56,7 %) participants étaient des femmes. Le score moyen du Older Americans Resources and Services scale évalué par l'assistant de recherche était de 25,1 ± 3,3 tandis que le score moyen autoévalué était de 26,4±2,5 (ICC: 0,81 [95% CI : 0,7-0,9]). Les scores moyens des 7 activités de la vie quotidienne étaient de 12,5 ± 1,8 pour l'évaluation de l'assistant de recherche et de 13,5 ± 0,9 pour l'autoévaluation (ICC:0,6 [95% CI : 0,4-0,7]). Les scores moyens des 7 activités instrumentales de la vie quotidienne étaient de 12,6 ± 1,8 et 12,9 ± 1,8 pour l'évaluation de l'assistant de recherche et l'autoévaluation, respectivement (ICC:0,9 [IC 95% : 0,8-0,9]).

Conclusion

Nos résultats indiquent que l'autoévaluation du statut fonctionnel par les patients âgés est possible au DU, et des résultats de fidélité interjuges allant de bons à modérés ont été obtenus. L’autoévaluation avec le Older Americans Resources and Services scale pourrait permettre d'identifier des patients nécessitant une évaluation gériatrique ou fonctionnelle plus approfondie, qui n'auraient pas été dépistés autrement.

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Acknowledgements

We would like to thank Pierre-Hugues Carmichael, Alexandra Nadeau, Matthieu Robitaille, Joannie Blais, and Elisabeth Nguyen for their help and support with this project. Dr. Jacques Lee is supported by the Schwartz/ Reisman Emergency Medicine Institute Inaugural Research Chair in Geriatric Emergency Medicine.

Funding

This work was supported by the Fondation du CHU de Québec-Université Laval (grant number 2853). VB has received a scholarship from the Université Laval, and from the Fonds de recherche du Québec-Santé (FRQ-S) and the Strategy for Patient-Oriented Research (SPOR). Those sponsors played no role in the design or in the conduct of this study.

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Correspondence to Marcel Émond.

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Ethics approval

The CHU de Québec-Université Laval Research Ethics Board approved this study (#2017–3527).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Boucher, V., Lamontagne, ME., Lee, J. et al. Self-assessment of functional status in older emergency department patients: a cross-over randomized pilot trial. Can J Emerg Med (2021). https://doi.org/10.1007/s43678-020-00073-9

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Keywords

  • Self-rated health
  • Patient-reported outcome measure
  • Functional status
  • Self-assessment
  • Emergency department