Comprehensive Geriatric Assessment in the Emergency Department: A Prospective Cohort Study of Process, Clinical, and Patient-Reported Outcomes

Figures & data

Table 1 Baseline Characteristics and Outcomes Post Index ED Attendance

	Total (N=133)	Admission (N=29)	Discharged Home* (N = 94)	Transitional Care (N = 7)	Inpatient Rehabilitation (N = 3)
Age, mean ± SD	82.43 (6.89)	81.51 (8.15)	82.51 (6.58)	83.57 (6.95)	86.33 (2.08)
Female, n (%)	95 (71.43)	22 (75.86)	64 (68.09)	7 (100)	2 (66.67)
Marital status, n (%)
Married	37 (27.82)	7 (24.14)	29 (30.85)	0 (0)	1 (33.33)
Widowed	67 (50.38)	10 (34.48)	50 (53.19)	5 (71.43)	2 (66.67)
Single	24 (18.05)	10 (34.48)	12 (12.77)	2 (28.57)	0 (0)
Separated	5 (3.76)	2 (6.89)	3 (3.19)	0 (0)	0 (0)
Ethnicity, n (%)
White Irish	128 (96.24)	29 (100)	89 (94.68)	7 (100)	3 (100)
Other White	3 (2.26)	0 (0)	3 (3.19)	0 (0)	0 (0)
Asian	2 (1.15)	0 (0)	2 (2.13)	0 (0)	0 (0)
Residential status, n (%)
Family	61 (45.86)	10 (34.48)	48 (51.06)	1 (14.29)	2 (66.67)
Alone	67 (50.38)	16 (55.17)	44 (46.81)	6 (85.71)	1 (33.33)
Other**	5 (3.76)	3 (10.34)	2 (2.13)	0 (0.00)	0 (0.00)
Educational level, n (%)
Primary	40 (30.53)	8 (27.59)	32 (34.78)	0 (0.00)	0 (0.00)
Secondary	64 (48.85)	14 (48.28)	42 (45.65)	6 (85.71)	2 (66.67)
Third level	24 (18.32)	7 (24.14)	16 (17.39)	1 (14.29)	0 (0.00)
Post-graduate	3 (2.29)	0 (0.00)	2 (2.17)	0 (0.00)	1 (33.33)
History of falls in past 3 months
Yes, n (%)	110 (83.33)	22 (75.86)	79 (84.04)	7 (100)	2 (66.67)
Source of referral, n (%)
Self	96 (72.18)	23 (79.31)	63 (67.02)	7 (100)	3 (100)
GP	27 (20.30)	3 (10.34)	24 (25.53)	0 (0.00)	0 (0.00)
OOH GP	6 (4.51)	3 (10.34)	3 (3.19)	0 (0.00)	0 (0.00)
Injury Unit	3 (2.26)	0 (0.00)	3 (3.19)	0 (0.00)	0 (0.00)
Other	1 (0.75)	0 (0.00)	1 (1.06)	0 (0.00)	0 (0.00)
Mode of arrival, n (%)
Private	42 (31.58)	4 (13.79)	36 (38.30)	2 (28.57)	0 (0)
Ambulance	91 (68.42)	25 (86.21)	58 (61.70)	5 (71.42)	3 (100)
Number of medications, mean ± SD	8.16 (3.58)	7.38 (3.45)	8.19 (3.62)	10.67 (2.50)	9.00 (5.66)
ISAR, median (IQR)	2.00 (1.00)	2.00 (1.00)	2.00 (1.00)	2.00 (1.00)	2.00 (0.50)
CCI, mean ± SD	3.02 (1.49)	3.00 (1.54)	3.05 (1.49)	3.14 (1.35)	2.00 (1.73)
BI, mean ± SD	15.87 (3.43)	13.93 (4.04)	16.60 (2.92)	15.86 (2.91)	12.00 (5.00)
CFS, median (IQR)	5.00 (1.00)	5.00 (1.00)	4.50 (1.00)	4.00 (1.00)	4.00 (1.00)
Cognitive Impairment (4AT 1–3***), Yes, N (%)	40 (30.08)	9 (31.03)	30 (31.91)	1 (14.29)	0 (0.00)
EQ-5D-5L mean ± SD
Mobility	2.60 (0.92)	3.14 (1.06)	2.36 (0.74)	2.86 (0.90)	4.33 (0.58)
Self-care	2.14 (0.84)	2.52 (0.99)	1.96 (0.68)	2.29 (1.13)	3.67 (0.58)
Usual activities	2.59 (0.92)	3.00 (1.95)	2.30 (0.74)	2.71 (0.76)	4.00 (0.00)
Pain/discomfort	2.37 (0.87)	2.59 (1.02)	2.26 (0.75)	2.57 (1.27)	3.33 (1.16)
Anxiety/depression	1.56 (0.70)	1.79 (0.77)	1.47 (0.65)	1.57 (0.98)	2.00 (0.00)
EQ-5D-5L Index Value mean ± SD	0.626 (0.252)	0.479 (0.330)	0.698 (0.162)	0.536 (0.303)	0.055 (0.219)
EQ VAS, mean ± SD	59.92 (15.50)	53.93 (19.02)	63.39 (12.49)	41.43 (18.64)	51.67 (12.58)
ED length of stay (hours), median (IQR)	15.14 (14.47)	25.21 (23.83)	11.83 (12.77)	17.32 (14.26)	21.01 (21.52)
PSQ-18 mean ± SD	49.98 (4.06)	49.50 (3.73)	50.15 (4.30)	48.67 (2.50)	52 (1.00)

Notes: *n = 1 discharged against medical advice. **“Other” residential status refers to living arrangements not fitting existing categories (for example, living with others, not family members). ***n =1 scored 4 or above indicating possible delirium ± cognitive impairment.

Abbreviations: SD, Standard deviation; GP, General Practitioner; OOH GP, Out-of-Hours General Practitioner; ISAR, Identification of Seniors at Risk; IQR, interquartile range; CCI, Charlson Comorbidity Index; BI, Barthel Index; CFS, Clinical Frailty Scale; EQ-5D-5L, EuroQoL 5-dimension 5-level; VAS, Visual Analogue Scale; ED, emergency department; PSQ-18, Patient Satisfaction Questionnaire-18.

Figure 1 Functional decline at hospital discharge.

Notes: Colour key: Green = Index ED attendance; Orange = Hospital discharge.

Abbreviation: ED, emergency department.

Table 2 Total Sample Logistic Regression Models

	ED Re-Attendance	Hospital Admission	NH Admission	CST OP Services	PC Services
30 days
Age, OR [CIs]	0.93 [0.83, 1.03]	0.94 [0.83, 1.05]	0.96 [0.88, 1.05]	0.98 [0.92, 1.05]	1.11* [1.00, 1.23]
Gender, OR [CIs]	2.53 [0.57, 9.42]	1.41 [0.32, 6.27]	0.14 [0.02, 1.12]	2.37 [0.98, 5.73]	0.99 [0.28, 3.59]
Polypharmacy, OR [CIs]	0.92 [−0.277, 0.099]	1.05 [0.86, 1.27]	1.06 [0.91, 1.24]	0.94[0.84, 1.06]	0.92 [0.79, 1.07]
Frailty, OR [CIs]	1.73 [0.79, 3.77]	1.83 [0.79, 4.25]	1.24 [0.66, 2.35]	1.46 [0.90, 2.37]	0.64 [0.33, 1.25]
Nagelkerke, R^2	0.094	0.069	0.117	0.073	0.122
Chi-Square	5.077	3.325	7.539	6.007	6.93
180 days
Age, OR [CIs]	0.97 [0.90, 1.05]	0.94 [0.86, 1.01]	0.99 [0.91, 1.08]	0.99 [0.92, 1.08]	1.04 [0.94, 1.14]
Gender, OR [CIs]	1.26 [0.48, 3.30]	1.60 [0.58, 4.43]	1.35 [0.40, 4.56]	0.78 [0.25, 2.40]	0.73 [0.20, 2.69]
Polypharmacy, OR [CIs]	1.08 [0.95, 1.22]	1.13 [0.99, 1.28]	0.98 [0.83, 1.15]	0.98 [0.85, 1.13]	1.05 [0.88, 1.26]
Frailty, OR [CIs]	1.04 [0.62, 1.76]	1.76* [1.00, 3.10]	2.24* [1.20, 4.55]	1.17 [0.67, 2.04]	0.94 [0.46, 1.91]
Nagelkerke, R^2	0.036	0.143	0.111	0.009	0.019
Chi-Square	2.625	10.734*	7.173	0.597	0.972

Note: *p<0.05.

Abbreviations: ED, emergency department; NH, nursing home; CST OP, community specialist team older people; PC, primary care; OR, odds ratio; CI, confidence interval.