Aoife Fallon

Frailty in emergency departments

1 UK Parliament. Psychoactive Substances Act 2016. http://services.parliament.uk/ bills/2015-16/psychoactivesubstances.html (accessed March 22, 2016). 2 European Monitoring Centre for Drugs and Drug Addiction. Report on the risk assessment of mephedrone in the framework of the Council Decision on new psychoactive substances. May, 2011. Luxembourg: Publications Offi ce of the European Union, 2011. http://www. emcdda.europa.eu/html.cfm/index116639EN. html (accessed Jan 12, 2016). 3 Public Health England. Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2014 to 31 March 2015. December, 2015. London: Public Health England, 2015. https://www.ndtms.net/ Publications/downloads/Adult%20 Substance%20Misuse/adult-statistics-fromthe-national-drug-treatment-monitoringsystem-2014-2015.pdf (accessed Jan 12, 2016). controlled in several other countries worldwide. Anecdotal evidence suggests that mephedrone is rarely used in the USA or Europe as a whole. However, there has been a strong increase in the number of people presenting for mephedrone treatment in England, 3 and mephedrone is regularly detected in post-mortem samples analysed at the Toxicology Unit, Imperial College London, from coroners’ jurisdictions across London and southeast England. The number of deaths in which mephedrone was detected in 2015 (n=34, 1·5% of total cases received) has increased since 2014 (n=22, 1·0%). The number of deaths associated with mephedrone is comparable to the number of deaths in which methylenedioxymethyl-amphetamine (MDMA), an established recreational drug, was detected (n=28, 1·2% of total cases in 2015 and n=25, 1·1% in 2014). These mephedrone-associated deaths occurred in three distinct user groups: recreational drug users who take the drug in combination with alcohol or other typical recreational drugs, such as cocaine, amphetamine, or MDMA; intravenous drug users combining mephedrone with heroin; and men who have sex with men (MSM) who combine the drug with γ-hydroxybutyrate and metamphetamine. In 2015, all mephedrone-associated deaths identifi ed by the Toxicology Unit were in men, 68% of whom were MSM. The authors of the European Monitoring Centre for Drugs and Drug Addiction report on the risk assessment of mephedrone in 2011 concluded that the decision to control the drug has the potential to reduce the availability and usage, but could also create an illicit market. Our data suggest that, despite being a controlled substance, mephedrone has remained popular on the London drug scene, and has become an established drug of choice in a diverse population of drug users. Frailty in emergency departments

212Screening Frailty in the Emergency Department: The Utility of the SHARE-FI in Predicting Outcomes in a Cohort of Older Patients

Background: Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for high risk patients. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) [1] was developed for use in the community but has been shown to be useful in the emergency department (ED). Objective: To measure frailty, review its prevalence in older patients presenting to ED and compare characteristics and outcomes of frail patients with their non-frail counterparts. Methods: Prospective cohort study was carried out with pre-specified convenience sampling of those aged ≥70 years presenting to ED on a 24/7 basis, from January-August 2014. Patient characteristics were recorded using the symphony electronic data system; SHARE-FI assessed frailty. Cognition, delirium and six and twelve month outcomes were reviewed. Binary logistic regression was used to estimate odds ratios for covariates. Results: Age predicted mortality (OR2.34, 95% CI1.30–4.21, p = 0.004) and the composite outcome of “alive and at home” at 12 months (OR0.49, 95% CI0.23–0.83, p = 0.009). Dementia (OR0.24, p = 0.005) and polypharmacy (OR0.37, 95% CI0.16–0.87, p = 0.022) were predictive of being alive and at home at twelve months. Frailty was not associated with a significant difference in mortality rates (OR0.89, 95% CI0.58–1.38, p = 0.614) or being alive and at home at 12 months (OR1.07, 95% CI0.72–1.57, p = 0.745). Conclusions: This study suggests SHARE-FI was an inappropriate screening instrument in the ED. It may be of greater use to treat all older patients as being at risk of adverse outcomes. New screening tools to assess older patients presenting to hospital are required. Reference 1. Romero-Ortuno R, Walsh CD, Lawlor BA, Kenny RA. A Frailty Instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 2010; 10: 57. doi:10.1186/1471-2318-10–57.

Missing in the Media: Cancer and Older People

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