Mobility assessments of geriatric emergency department patients: A systematic review

Abstract

Objectives: We wished to determine the impact of emergency department (ED) mobility assessments for older patients on hospitalization, return visits, future falls, and frailty.

Methods: We searched MEDLINE, Embase, CINAHL, Cochrane Library, PEDro, and OTseeker (September 2016). Two independent reviewers identified studies of patients ≥65 years with ED physical mobility assessments and outcomes of hospitalization, return to ED, falls, and frailty. Language was not restricted. Only clinical trials and observational studies were included.

Results: We identified 1,365 unique citations. Nine studies (six cohort and three cross-sectional) met full inclusion criteria. Patients (n=2,513) with mean age 75-85 years, admitted to hospital and discharged, underwent these ED evaluations: Timed Up and Go (TUG), Get Up and Go, tandem walk, and a gait assessment. Study quality was moderate to poor. Tandem walk did not predict falls at 90 days. TUG was not associated with return to the ED/hospitalization at 90 days. Get Up and Go was associated with hospital admission but not return to ED visits at 1 or 3 months. Due to clinical heterogeneity in study populations and outcomes, a meta-analysis was not undertaken.

Conclusions: Despite multiple guidelines recommending a mobility assessment prior to ED discharge for older patients, we found that such assessments were neither associated with nor predictive of adverse outcomes. Robust research is required to guide clinicians on the utility of physical mobility assessments in older ED patients.

Keywords: emergency department; geriatrics; mobility.