https://orcid.org/0000-0001-9984-9204
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Abstract
Background
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.
Data Sharing Statement
All deidentified data files and data dictionary, and no analytic code can be obtained by contacting the corresponding author.
Consent for Publication
Written informed consent was obtained from all participants who were recruited during the duration of the study.
Acknowledgments
The corresponding author is grateful to all the older adults and those important to them who were recruited to this study and engaged in follow-up after their ED attendance. She is also grateful to all the co-authors who shared their time and expertise during the period of study completion.
Author Contributions
ÍO’S was responsible for conceptualization of the study, design of the work, analysis, and interpretation of the data, and writing the initial draft of the manuscript. RG obtained research grant funding and was responsible for conceptualization of the study, design of the work, analysis and interpretation of the data, supervision, and revised the manuscript from a critical perspective to enhance its contents. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.