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Observational Study
. 2024 Feb 7:19:189-201.
doi: 10.2147/CIA.S434641. eCollection 2024.

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

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 Galvin  1
Affiliations
Observational Study

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

Íde O'Shaughnessy et al. Clin Interv Aging. .

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.

Keywords: adverse outcomes; emergency care; frailty; integrated care; longitudinal study.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Functional decline at hospital discharge.
See this image and copyright information in PMC

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