EMS Assessment of falls risk, nutritional risk, and cognitive impairment among older patients

Eeva Saario, Marja Mäkinen, Finland

Professor Maaret Castrén's research group has developed a risk assessment method as a part of normal treatment practices in the emergency medical services (EMS) in Uusimaa, Finland.

The purpose was to assess the falls risk, nutritional risk, and cognitive impairment in patients over 70 years old. It is widely known that falls, malnutrition, and cognitive impairment are common health problems among older patients, and the early recognition of patients experiencing these health problems is important. The aim was to improve the ability of the EMS to recognize older patients in need of care.  This was the first time the EMS has performed such risk assessments in the pre-hospital setting.

The EMS risk assessment method was put into everyday use for patients over 70 requiring non-urgent ambulance transfer to the emergency department (ED) in 2018. The risk assessment was performed during transportation, and the screening tool designed for the EMS was placed in the real-time electronic patient reporting and management system.

The falls risk was assessed by the ED falls risk tool supplemented by a selected question from the Peninsula Health Falls Risk Assessment Tool (PH-FRAT). The ED falls risk tool is a simple, two-item tool focused on prediction of falls. Of the 4-item PH-FRAT, the question about self-reported falls over a 12-month period was chosen. Nutritional risk was assessed by the Nutritional Risk Screening Tool 2002 (NRS-2002) with a slight modification. The body mass index was excluded from the EMS risk screening tool, as the EMS had no suitable measuring equipment for height and weight measurements. Cognitive impairment was assessed by the 4AT, which includes the Abbreviated Mental Test (AMT4). 

Promising results from the use of the risk assessment method were obtained. Between 10/2018 and 07/2019, the EMS performed the risk assessment on 488 patients, representing 8% of the 5792 non-urgent transfers to the ED. Most patients were female (n=303, 62%) and mean age was 82.8 ±5.4 years (range 70.3 t0 103.7 years). A total of 81 patients (16%) were at nutritional risk, 209 (43%) at falls risk, and 137 patients (28%) had cognitive impairment. Most patients (n=292, 60%) were assessed to be in at least one at risk group and 22 patients (5%) had a positive risk screening result in all three categories.

It was confirmed that the EMS can identify patients with nutritional risk, falls risk, and cognitive impairment by using a simple screening tool. These health problems were common, and their prevalence in the EMS was consistent with previous studies from the in-hospital environment.

Based on the results so far, we recommend that the risk assessment should become a regular task in the EMS. It could be beneficial for the EMS to execute the risk assessment in future also to non-conveyed patients.