TY - JOUR
T1 - Comprehensive Geriatric Assessment in the Emergency Department
T2 - A Prospective Cohort Study of Process, Clinical, and Patient-Reported Outcomes
AU - O’shaughnessy, Íde
AU - Robinson, Katie
AU - Whiston, Aoife
AU - Barry, Louise
AU - Corey, Gillian
AU - Devlin, Collette
AU - Hartigan, Deirdre
AU - Synnott, Aoife
AU - McCarthy, Aoife
AU - Moriarty, Eoin
AU - Jones, Bryan
AU - Carroll, Ida
AU - Shchetkovsky, Denys
AU - O’connor, Margaret
AU - Steed, Fiona
AU - Carey, Leonora
AU - Conneely, Mairéad
AU - Leahy, Aoife
AU - Quinn, Colin
AU - Shanahan, Elaine
AU - Ryan, Damien
AU - Galvin, Rose
N1 - Publisher Copyright:
© 2024 O’Shaughnessy et al.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - adverse outcomes
KW - emergency care
KW - frailty
KW - integrated care
KW - longitudinal study
UR - http://www.scopus.com/inward/record.url?scp=85185136771&partnerID=8YFLogxK
U2 - 10.2147/CIA.S434641
DO - 10.2147/CIA.S434641
M3 - Article
C2 - 38343726
AN - SCOPUS:85185136771
SN - 1176-9092
VL - 19
SP - 189
EP - 201
JO - Clinical Interventions in Aging
JF - Clinical Interventions in Aging
ER -