Interventions that have potential to help older adults living with social frailty: a systematic scoping review.

BACKGROUND: The impact of social frailty on older adults is profound including mortality risk, functional decline, falls, and disability. However, effective strategies that respond to the needs of socially frail older adults are lacking and few studies have unpacked how social determinants operate or how interventions can be adapted during periods requiring social distancing and isolation such as the COVID-19 pandemic. To address these gaps, we conducted a scoping review using JBI methodology to identify interventions that have the best potential to help socially frail older adults (age ≥65 years). METHODS: We searched MEDLINE, CINAHL (EPSCO), EMBASE and COVID-19 databases and the grey literature. Eligibility criteria were developed using the PICOS framework. Our results were summarized descriptively according to study, patient, intervention and outcome characteristics. Data synthesis involved charting and categorizing identified interventions using a social frailty framework.  RESULTS: Of 263 included studies, we identified 495 interventions involving ~124,498 older adults who were mostly female. The largest proportion of older adults (40.5%) had a mean age range of 70-79 years. The 495 interventions were spread across four social frailty domains: social resource (40%), self-management (32%), social behavioural activity (28%), and general resource (0.4%). Of these, 189 interventions were effective for improving loneliness, social and health and wellbeing outcomes across psychological self-management, self-management education, leisure activity, physical activity, Information Communication Technology and socially assistive robot interventions. Sixty-three interventions were identified as feasible to be adapted during infectious disease outbreaks (e.g., COVID-19, flu) to help socially frail older adults. CONCLUSIONS: Our scoping review identified promising interventions with the best potential to help older adults living with social frailty.

The emergency department experience of patients with early pregnancy complications: A qualitative study.

OBJECTIVE: The purpose of this qualitative study was to explore the experiences and perceptions of care of women treated for early pregnancy complications in a Canadian emergency department (ED) and early pregnancy clinic (EPC). METHODS: We conducted a descriptive qualitative study to understand the perceptions, meanings, and perspectives of women of 18 years and older who presented to the ED or EPC of an urban, tertiary care hospital with early pregnancy complications or loss. Using a semi-structured interview guide, a 45- to 60-minute telephone interview was conducted by a trained qualitative interviewer at 4 to 6 weeks after the ED visit. All interviews were digitally recorded and transcribed verbatim for analysis. Data analysis occurred in conjunction with data collection in order to continuously monitor emerging themes and general areas for further exploration. Interviews were conducted until thematic saturation had occurred. RESULTS: Interviews were completed with 30 women between June and August 2018. Three key themes arose: disconnect of the ED's role in the provision of care, normalization of a chaotic healthcare experience, and finding connection through the institution's EPC. CONCLUSIONS: Perspectives of women with early pregnancy complications highlight the ways in which ED care often does not meet the expectations or needs of patients and their families. The emotional complexity of this medical situation is often overlooked by ED staff and can produce encounters that are distressing. However, negative experiences were often mitigated by follow-up care in the institution's EPC.

INTRODUCTION: L'étude qualitative portait sur l'expérience vécue par des femmes traitées pour des complications en début de grossesse dans un service des urgences (SU) au Canada ou dans une clinique spécialisée dans la prise en charge des troubles du début de la grossesse, ainsi que sur leur impression des soins reçus. MÉTHODE: Il s'agit d'une étude qualitative et descriptive visant à connaître l'impression que des femmes âgées de 18 ans et plus avaient des soins reçus dans un SU d'un centre hospitalier de soins tertiaires situé en milieu urbain pour des complications en début de grossesse ou un avortement, ou dans une clinique spécialisée en la matière; à cet élément s'ajoutent la portée de l'expérience vécue et le point de vue des participantes. Des entretiens téléphoniques semi-directifs, d'une durée de 45 à 60 minutes ont été effectués de 4 à 6 semaines après la consultation au SU, à l'aide d'un guide, par une personne ayant reçu une formation en recherche qualitative. Les entretiens ont tous été enregistrés sous forme numérique et transcrits textuellement aux fins d'analyse. La collecte de données ainsi que l'analyse des donnés se sont déroulées en parallèle afin de permettre un suivi continu de l'émergence de nouveaux thèmes ou d'éléments généraux nécessitant un examen approfondi. Les entretiens se sont poursuivis jusqu'à l'atteinte du point de saturation thématique. RÉSULTATS: Trente femmes ont participé à l'étude, entre juin et août 2018. Trois grands thèmes se sont dégagés des entretiens, soit le manque d'empathie du personnel au SU, la normalisation d'une prestation chaotique des soins de santé et, en revanche, le sentiment de compréhension ressenti à la clinique spécialisée, rattachée à l'établissement. CONCLUSIONS: Le point de vue des femmes ayant vécu des complications en début de grossesse met en lumière le fait que souvent la prestation des soins au SU ne répond pas aux besoins et aux attentes des patientes et de leur famille. La complexité de la charge émotive liée au problème médical est bien des fois négligée par le personnel au SU, ce qui peut donner lieu à des situations pénibles. Toutefois, l'expérience défavorable vécue par les femmes est souvent atténuée par le suivi assuré à la clinique spécialisée, rattachée à l'établissement.

A qualitative study of emergency physicians' perspectives on PROMS in the emergency department.

INTRODUCTION: There is a growing emphasis on including patients' perspectives on outcomes as a measure of quality care. To date, this has been challenging in the emergency department (ED) setting. To better understand the root of this challenge, we looked to ED physicians' perspectives on their role, relationships and responsibilities to inform future development and implementation of patient-reported outcome measures (PROMs). METHODS: ED physicians from hospitals across Canada were invited to participate in interviews using a snowballing sampling technique. Semistructured interviews were conducted by phone with questions focused on the role and practice of ED physicians, their relationship with their patients and their thoughts on patient-reported feedback as a mechanism for quality improvement. Transcripts were analysed using a modified constant comparative method and interpretive descriptive framework. RESULTS: Interviews were completed with 30 individual physicians. Respondents were diverse in location, training and years in practice. Physicians reported being interested in 'objective' postdischarge information including adverse events, readmissions, other physicians' notes, etc in a select group of complex patients, but saw 'patient-reported' feedback as less valuable due to perceived biases. They were unsure about the impact of such feedback mainly because of the episodic nature of their work. Concerns about timing, as well as about their legal and ethical responsibilities to follow-up if poor patient outcomes are reported, were raised. CONCLUSIONS: Data collection and feedback are key elements of a learning health system. While patient-reported outcomes may have a role in feedback, ED physicians are conflicted about the actionability of such data and ethical implications, given the inherently episodic nature of their work. These findings have important implications for PROM design and implementation in this unique clinical setting.