Clinical Interventions in Aging (Feb 2024)
Comprehensive Geriatric Assessment in the Emergency Department: A Prospective Cohort Study of Process, Clinical, and Patient-Reported Outcomes
Abstract
Íde O’Shaughnessy,1 Katie Robinson,1 Aoife Whiston,1 Louise Barry,2 Gillian Corey,1 Collette Devlin,1 Deirdre Hartigan,1 Aoife Synnott,3 Aoife McCarthy,4 Eoin Moriarty,5 Bryan Jones,6 Ida Carroll,5 Denys Shchetkovsky,7 Margaret O’Connor,5,8 Fiona Steed,9 Leonora Carey,4 Mairéad Conneely,1 Aoife Leahy,5 Colin Quinn,5 Elaine Shanahan,5 Damien Ryan,7,8 Rose Galvin1 1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 2Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland; 3Department of Physiotherapy, University Hospital Limerick, Limerick, Ireland; 4Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland; 5Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland; 6Department of Medical Social Work, University Hospital Limerick, Limerick, Ireland; 7Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland; 8School of Medicine, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 9Department of Health, Government of Ireland, Dublin, IrelandCorrespondence: Íde O’Shaughnessy, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Tel +35361234149, Email [email protected]: This study aimed to explore the process, clinical, and patient-reported outcomes of older adults who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the emergency department (ED) over a six-month period after their initial ED attendance.Patients and Methods: A prospective cohort study recruited older adults aged ≥ 65 years who presented to the ED of a university teaching hospital in Ireland. Baseline assessment data comprising a battery of demographic variables and validated indices were obtained at the index ED attendance. Telephone interviews were completed with participants at 30- and 180-day follow-up. The primary outcome was incidence of hospital admission following the index ED attendance. Secondary outcomes included participant satisfaction, incidence of functional decline, health-related quality of life, incidence of unscheduled ED re-attendance(s), hospital (re)admission(s), nursing home admission, and death.Results: A total of 133 participants (mean age 82.43 years, standard deviation = 6.89 years; 71.4% female) were recruited; 21.8% of the cohort were admitted to hospital following the index ED attendance with a significant decline in function reported at hospital discharge (Z = 2.97, p = 0.003). Incidence of 30- and 180-day unscheduled ED re-attendance was 10.5% and 24.8%, respectively. The outcome at the index ED attendance was a significant predictor of adverse outcomes whereby those who were discharged home had significantly lower odds of multiple adverse process outcomes at 30- and 180-day follow-up, and significantly higher function and health-related quality of life at 30-day follow-up.Conclusion: While this study was observational in nature, findings suggest CGA in the ED may improve outcomes by mitigating against the adverse effects of potentially avoidable hospital admissions and focusing on a longitudinal approach to healthcare delivery at the primary-secondary care interface. Future research should be underpinned by an experimental study design to address key limitations in this study.Keywords: frailty, emergency care, longitudinal study, adverse outcomes, integrated care
