{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T14:53:54Z","timestamp":1774450434572,"version":"3.50.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Conselho Nacional de Desenvolvimento Cient\u00c3fico e Tecnol\u00c3\u00b3gi","award":["305462\/2024-5"],"award-info":[{"award-number":["305462\/2024-5"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The aging of the population is a global phenomenon, with projections indicating a significant increase in the proportion of individuals aged 65 years and older by 2050. This demographic shift requires adapting emergency department (ED) services to meet the specific demands of older patients, who often present with multiple comorbidities and face challenges such as sensory and cognitive difficulties. EDs, traditionally designed for acute illness and injury management, may not be adequately equipped to meet the unique needs of this vulnerable population. This can result in suboptimal patient experiences, prolonged ED stays, increased hospitalizations, and poorer outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study protocol outlines a before-and-after study to evaluate the impact of implementing a comfort menu and cart on the experience and outcomes of older patients treated in the ED. The study will be conducted in the ED of Hospital S\u00edrio-Liban\u00eas (HSL), a tertiary private hospital in S\u00e3o Paulo, Brazil. Patients aged 65 and older who presented to the ED will be eligible for inclusion. Participants will be recruited in two phases: pre-intervention and post-implementation of the comfort menu and cart. Data will be collected through patient and staff interviews, chart reviews, and a 30-day follow-up interview. Patient experience, staff experience, length of hospital stays, hospital costs, ED readmissions, falls, delirium incidence, quality of life, functional status, cognitive performance, and mortality will be assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Expected results<\/jats:title>\n                    <jats:p>We expect to demonstrate the positive impact of implementing the comfort menu and cart in the ED on patient-centered outcomes. We anticipate improvements in the experience of older patients and medical and multidisciplinary staff, and hope to identify improvements in other exploratory outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT06681376.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0332773","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:49:27Z","timestamp":1764874167000},"page":"e0332773","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhancing the emergency department experience for older adults: Study protocol for the implementation of a comfort menu and cart"],"prefix":"10.1371","volume":"20","author":[{"given":"Silvia A.","family":"Ferreira","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda","family":"Bellolio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7503-8810","authenticated-orcid":true,"given":"Susan M.","family":"Bower","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6255-8074","authenticated-orcid":true,"given":"Luis Fernando","family":"Penna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magali A. L.","family":"Marion","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlon R.","family":"Aliberti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thiago J.","family":"Avelino-Silva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1573-5857","authenticated-orcid":true,"given":"Christian V.","family":"Morinaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8544-1635","authenticated-orcid":true,"given":"Pedro Kallas","family":"Curiati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"pone.0332773.ref001","volume-title":"World Population Prospects","author":"Affairs DoEaS"},{"issue":"6","key":"pone.0332773.ref002","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.annemergmed.2018.01.009","article-title":"How Older Adults Experience an Emergency Department Visit: Development and Validation of Measures","volume":"71","author":"J McCusker","year":"2018","journal-title":"Ann Emerg Med"},{"key":"pone.0332773.ref003","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ajem.2020.04.089","article-title":"Non-pharmacologic interventions improve comfort and experience among older adults in the Emergency Department","volume":"39","author":"IM Lichen","year":"2021","journal-title":"Am J Emerg Med"},{"issue":"5","key":"pone.0332773.ref004","article-title":"Geriatric emergency department guidelines","volume":"63","author":"American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, Society for Academic Emergency Medicine, Geriatric Emergency Department Guidelines Task Force","year":"2014","journal-title":"Ann Emerg Med"},{"key":"pone.0332773.ref005","article-title":"Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine","author":"JA Lucke","year":"2021","journal-title":"Eur Geriatr Med"},{"issue":"3","key":"pone.0332773.ref006","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/DCC.0000000000000415","article-title":"Implementing a Comfort Care Cart: A Quality Improvement Nurse-Driven Initiative in the Intensive Care Unit","volume":"39","author":"KA Stolzman","year":"2020","journal-title":"Dimens Crit Care Nurs"},{"issue":"1","key":"pone.0332773.ref007","first-page":"1","article-title":"Methods for Analysis of Pre-Post Data in Clinical Research: A Comparison of Five Common Methods","volume":"8","author":"NS O\u2019Connell","year":"2017","journal-title":"J Biom Biostat"},{"key":"pone.0332773.ref008","unstructured":"S\u00edrio-Liban\u00eas - Conhecer para cuidar Internet: Hospital S\u00edrio-Liban\u00eas; [Available from: https:\/\/www.hospitalsiriolibanes.org.br\/institucional\/Paginas\/default.aspx"},{"key":"pone.0332773.ref009","unstructured":"Pronto Atendimento Internet: Hospital S\u00edrio-Liban\u00eas; [Available from: https:\/\/www.hospitalsiriolibanes.org.br\/hospital\/Paginas\/pronto-atendimento.aspx"},{"issue":"3","key":"pone.0332773.ref010","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.annemergmed.2020.01.010","article-title":"Predicting Hospital Admission and Prolonged Length of Stay in Older Adults in the Emergency Department: The PRO-AGE Scoring System","volume":"76","author":"PK Curiati","year":"2020","journal-title":"Ann Emerg Med"},{"key":"pone.0332773.ref011","unstructured":"Physicians ACoE. Geriatric Emergency Department Accreditation. Available from: https:\/\/www.acep.org\/geda"},{"issue":"5","key":"pone.0332773.ref012","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"ME Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"1","key":"pone.0332773.ref013","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jclinepi.2014.09.010","article-title":"A systematic review identifies valid comorbidity indices derived from administrative health data","volume":"68","author":"M Yurkovich","year":"2015","journal-title":"J Clin Epidemiol"},{"issue":"12","key":"pone.0332773.ref014","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1016\/j.jclinepi.2008.01.006","article-title":"The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients","volume":"61","author":"ME Charlson","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"pone.0332773.ref015","article-title":"Comorbidity indices","volume":"32","author":"A Molt\u00f3","year":"2014","journal-title":"Clin Exp Rheumatol"},{"key":"pone.0332773.ref016","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ajem.2024.02.020","article-title":"Risk of falls is associated with 30-day mortality among older adults in the emergency department","volume":"79","author":"MP Hamilton","year":"2024","journal-title":"Am J Emerg Med"},{"issue":"7","key":"pone.0332773.ref017","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1111\/acem.14888","article-title":"Predicting posthospitalization falls in Brazilian older adults: External validation of the Carpenter instrument","volume":"31","author":"PK Curiati","year":"2024","journal-title":"Acad Emerg Med"},{"issue":"3","key":"pone.0332773.ref018","doi-asserted-by":"crossref","first-page":"210","DOI":"10.5770\/cgj.23.463","article-title":"Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources","volume":"23","author":"K Rockwood","year":"2020","journal-title":"Can Geriatr J"},{"issue":"3","key":"pone.0332773.ref019","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.annemergmed.2020.03.028","article-title":"Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department","volume":"76","author":"T Kaeppeli","year":"2020","journal-title":"Ann Emerg Med"},{"key":"pone.0332773.ref020","article-title":"National Early Warning Score 2: adapta\u00e7\u00e3o transcultural para o portugu\u00eas do Brasil","author":"APA de Oliveira","year":"2020","journal-title":"Revista Ga\u00facha de Enfermagem"},{"issue":"1","key":"pone.0332773.ref021","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1093\/ageing\/afaa240","article-title":"A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults","volume":"50","author":"MJR Aliberti","year":"2021","journal-title":"Age Ageing"},{"key":"pone.0332773.ref022","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.jad.2019.08.053","article-title":"Usefulness of the 15-item geriatric depression scale (GDS-15) for classifying minor and major depressive disorders among community-dwelling elders","volume":"259","author":"C Shin","year":"2019","journal-title":"J Affect Disord"},{"issue":"5","key":"pone.0332773.ref023","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.annemergmed.2013.05.003","article-title":"Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method","volume":"62","author":"JH Han","year":"2013","journal-title":"Ann Emerg Med"},{"key":"pone.0332773.ref024","unstructured":"Foundation ER. EQ-5D-3L User Guide. 2018."},{"key":"pone.0332773.ref025","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1001\/jama.1963.03060120024016","article-title":"Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function","volume":"185","author":"S Katz","year":"1963","journal-title":"JAMA"},{"issue":"3","key":"pone.0332773.ref026","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: self-maintaining and instrumental activities of daily living","volume":"9","author":"MP Lawton","year":"1969","journal-title":"Gerontologist"},{"key":"pone.0332773.ref027","first-page":"61","article-title":"Functional evaluation: the Barthel index","volume":"14","author":"FI Mahoney","year":"1965","journal-title":"Md State Med J"},{"issue":"1","key":"pone.0332773.ref028","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/gps.4282","article-title":"Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS)","volume":"31","author":"D Apolinario","year":"2016","journal-title":"Int J Geriatr Psychiatry"},{"issue":"9","key":"pone.0332773.ref029","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1111\/jgs.12973","article-title":"Delirium recognition by family: European Portuguese validation study of the family confusion assessment method","volume":"62","author":"S Martins","year":"2014","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"pone.0332773.ref030","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"PA Harris","year":"2009","journal-title":"J Biomed Inform"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332773","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:49:33Z","timestamp":1764874173000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332773"}},"subtitle":[],"editor":[{"given":"Emma","family":"Campbell","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,4]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0332773","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,4]]}}}