The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients

Ula Hwang^{1

2}, Natalia Sifnugel¹, Inessa Cohen^{3

4

5}, Ling Han⁶, Katy Araujo⁶, Luann M Bianco⁶, Cynthia A Brandt⁴, Sandra Capelli⁶, Christopher R Carpenter⁷, Daniel S Cruz⁸, Scott M Dresden⁸, Ivy L Fishman⁸, Katrina Gipson⁹, S Nicole Hastings^{10

11}, William W Hung^{2

12}, Raymond Kang¹³, Mechelle Lockhart¹⁴, Daniella Meeker⁴, Ugochi Ohuabunwa¹⁴, Sierra Ottilie-Kovelman⁶, Caitlin Partridge¹⁵, Timothy F Platts-Mills¹⁶, Jacqueline Sandoval³, Zachary Taylor⁸, Debra F Tomasino¹, Camille P Vaughan^{14

17}

Affiliations

¹ Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA.
² Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.
³ Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
⁴ Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA.
⁵ Program of Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA.
⁶ Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
⁷ Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁸ Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁹ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁰ Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
¹¹ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.
¹² Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹³ Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁴ Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁵ Joint Data Analysis Team (JDAT), Yale Biomedical Informatics and Computing, Research Informatics Office, Yale University, New Haven, Connecticut, USA.
¹⁶ Ophirex, Inc., Corte Madera, California, USA.
¹⁷ VA Atlanta Health Care System, Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC) Atlanta, Atlanta, Georgia, USA.

PMID: 40650481
PMCID: PMC12266642 (available on 2026-07-12)
DOI: 10.1111/acem.70101

The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients

Ula Hwang et al. Acad Emerg Med. 2025.

. 2025 Jul 12:10.1111/acem.70101.

doi: 10.1111/acem.70101. Online ahead of print.

Authors

Affiliations

¹ Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA.
² Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.
³ Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
⁴ Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA.
⁵ Program of Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA.
⁶ Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
⁷ Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁸ Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁹ Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁰ Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
¹¹ Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.
¹² Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹³ Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁴ Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁵ Joint Data Analysis Team (JDAT), Yale Biomedical Informatics and Computing, Research Informatics Office, Yale University, New Haven, Connecticut, USA.
¹⁶ Ophirex, Inc., Corte Madera, California, USA.
¹⁷ VA Atlanta Health Care System, Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC) Atlanta, Atlanta, Georgia, USA.

PMID: 40650481
PMCID: PMC12266642 (available on 2026-07-12)
DOI: 10.1111/acem.70101

Abstract

Objectives: Multicenter research of geriatric emergency department (GED) care remains limited. Our objectives were to: 1. Prospectively collect data prioritized by the Geriatric Emergency care Applied Research (GEAR) network, a transdisciplinary taskforce for GED care, and create a multicenter GED research repository of prospective and electronic health record (EHR) data, 2. Assess concordance between prospective and EHR data.

Methods: The GEAR Standardization Study (GEARSS) is a multicenter, prospective study of older emergency department (ED) patients (65+) focusing on the 4Ms of age-friendly care (mobility, medication safety, mentation, what matters) and elder mistreatment. Demographic and clinical data were collected via interviews by trained research assistants (RA) on Days 0, 4, 30, and 90 and linked to EHR. Prevalence of chronic comorbidities and incident delirium were measured and reported using descriptive statistics. Prospective and EHR data concordance was assessed with Cohen's Kappa.

Results: 999 participants were recruited from 5 EDs (3/25/2021-6/30/2022) across 3 institutions: Grady Health System, Northwestern Memorial Hospital, and Yale New Haven Health. The cohort was 57.0% female, 55.2% White, 39.1% Black, and 3.4% Hispanic, and the mean age was 75.1 years. For rheumatologic disease, peptic ulcer disease, diabetes, renal disease, and cancer, prevalence differed between prospective and EHR data by > 10%. About two-thirds of participants were at risk for falls. Concordance between prospective and EHR data was good for ethnicity (K = 0.73); excellent for sex (K = 1.00), age (K = 1.00), and race (K = 0.98); fair for disposition (K = 0.53); slight for ED observation status (K = 0.33) and dementia diagnosis (K = 0.24); poor for delirium presence (K = 0.07).

Conclusion: In GEARSS, demographic variables aligned strongly between prospective and EHR data, while diagnosis, disposition, and mentation factors did not. This multicenter data source provides preliminary findings for common geriatric syndromes and conditions. Choice of measures using these data should be driven by GED research questions.

Keywords: age‐friendly; emergency department; geriatrics; multicenter.

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Conflict of interest statement

Conflict of interest disclosures: CRC is Associate Editor for the Journal of the American Geriatrics Society, leads the Society for Academic Emergency Medicine Guidelines for Reasonable and Appropriate Care in the Emergency Department committee, serves on the American College of Emergency Physicians Clinical Policy Committee, is Chair of the American College of Emergency Physician’s Geriatric Emergency Department Accreditation Advisory Board, serves on the Clinician-Scientist Transdisciplinary Aging Research Leadership Core, and is an editor for the American College of Emergency Physician’s MyEMCert program.

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The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients

Affiliations

The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources