Care of frail and older adults: A content analysis of paramedic operational clinical practice guidelines

Wayne Harris; Christine Stirling; Anne-Marie Williams; Peter Lucas

doi:10.1016/j.ienj.2021.101007

Care of frail and older adults: A content analysis of paramedic operational clinical practice guidelines

Int Emerg Nurs. 2021 May:56:101007. doi: 10.1016/j.ienj.2021.101007. Epub 2021 Apr 16.

Authors

Wayne Harris¹, Christine Stirling², Anne-Marie Williams³, Peter Lucas⁴

Affiliations

¹ Tasmanian School of Medicine, College of Health and Medicine, Division of Paramedicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia. Electronic address: Wayne.harris@utas.edu.au.
² School of Nursing, College of Health and Medicine, University of Tasmania, Private Bag 135, Hobart 7001, Tasmania, Australia. Electronic address: Christine.stirling@utas.edu.au.
³ Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia. Electronic address: Annemarie.williams@utas.edu.au.
⁴ Tasmanian School of Medicine, College of Health and Medicine, Division of Paramedicine, University of Tasmania, Private Bag 34, Hobart 7001, Tasmania, Australia. Electronic address: p.v.lucas@utas.edu.au.

PMID: 33872941
DOI: 10.1016/j.ienj.2021.101007

Abstract

Introduction: Frailty rates are increasing with population ageing. In paramedicine, Clinical Practice Guidelines (CPGs) are essential documents that support decision making, yet little evidence exists regarding the support CPGs provide paramedics in the care of frail and older adults.

Aim: To investigate how CPGs support paramedics' care of frail and older adults.

Methods: CPGs from nine Australasian paramedic services were collected in 2019. Content analysis was used to explore two hundred and thirty-seven individual CPGs for decision support information regarding frail and older adults.

Results: Evidence-based content relating to older adults was sparse compared to paediatric content. Two overarching decision support domains were identified, patient assessment and management. Inconsistent age descriptors were widespread, particularly in pharmacological guidelines. Five service providers' CPGs contained validated assessment instruments for use with older adults.

Conclusion: Decision support documentation regarding frail and older adults varies across Australasian paramedic services. Frailty and older adult specific CPGs, and validated assessment instruments suitable to the paramedicine environment could improve paramedic decision making and minimise patient risk. A collaborative approach encompassing service providers and educational institutions is crucial to develop consistent, evidence-based CPGs relevant to older adults.

Keywords: Aged; Clinical practice guidelines; Content analysis; Frail elderly; Geriatrics; Paramedic.

MeSH terms

Aged
Allied Health Personnel
Child
Emergency Medical Services*
Emergency Medical Technicians*
Frail Elderly
Health Services for the Aged*
Humans
Practice Guidelines as Topic