Development of a new triage method for emergency medical transfer from elderly long-term care facilities: Utilizing caregiver daily impression (CDI) combined with physical findings

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K15901
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: General internal medicine(including psychosomatic medicine)
• Research Institution: Jichi Medical University
• Principal Investigator: Ae Ryusuke 自治医科大学, 医学部, 講師 (70554567)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: ＣＤＩ / 高齢者介護 / 特別養護老人ホーム / 老年医学 / プライマリーケア

Outline of Final Research Achievements

We previously proposed the concept of caregiver daily impression (CDI) as a practical tool for emergency triage.
In the present study, we developed a standardized CDI checklist utilized in elderly long-term care facilities, aiming to obtain information on CDI that caregivers focus attention on subtle changes in daily functioning, which were difficult for caregivers to verbalize clearly. We experimentally started to use the checklist in a single facility.
Accumulated data showed that CDI was perceived several days before the onset of pneumonia among elderly residents. However, CDI was much less likely to perceive before the onset of urinary tract infection, biliary tract infection, and falls, indicating that these events might progress rapidly with the sudden onsets. We found pneumonia was the most common infectious disease among elderly residents in a long-term care facility, and CDI might contribute to the early diagnosis. Furthermore, CDI might predict the death of elderly residents.

Free Research Field

老年医学

Academic Significance and Societal Importance of the Research Achievements

高齢者の肺炎は発熱を欠くことがあり，重症化に伴い致命的な状態に陥るまでバイタルサインに異常を来さないこともある．一方で肺炎は，日常診療で高頻度に遭遇する疾病である．
ＣＤＩは肺炎の早期診断に寄与し得ることが本研究で示唆された．ＣＤＩを介して肺炎を早期に診断できれば，早期の治療により重症化を予防できる．ＣＤＩの有用性を示すエビデンスの蓄積は，介護スタッフの目利き力・判断力の信頼性を向上させる．介護スタッフの判断力が適切であれば，医療者を介さなくても高齢者の健康状態をスクリーニングできる．このことは，医療・福祉の効果的な機能分担や連携にも役立つ．