Comprehensive Geriatric Assessment in the Emergency Department

June 20, 2023 updated by: IDE O SHAUGHNESSY, University of Limerick

Comprehensive Geriatric Assessment in the Emergency Department: a Prospective Cohort Study of Clinical and Process Outcomes

Comprehensive geriatric assessment (CGA) has been shown to improve outcomes in an inpatient setting; however, there is currently no compelling evidence of benefit for CGA interventions within the Emergency Department (ED). This study aims to explore the clinical and process outcomes of older adults who receive interdisciplinary ED-CGA over a period of six months after their initial ED attendance.

Study Overview

Status

Completed

Conditions

Detailed Description

The significant growth in ED attendances is a growing public health issue, with attendances by older adults accelerating over the past decade, beyond that due to population ageing alone. The reasons underlying older adults higher rate of healthcare utilisation, specifically ED usage, are multifaceted. However, the most potent intrinsic factor is the clinical condition of frailty. The presence of diminished homeostatic reserves leaves older adults more susceptible to acute exacerbations of comorbid and long-term conditions, which result in a concomitant increased demand for emergency care.

A presentation to an ED can be viewed as a sentinel event for an older adult. Conversely, it affords clinicians an opportunity to identify a high risk cohort followed by delivery of a holistic and bio-psychosocial intervention to mitigate against suboptimal outcomes. CGA is considered the gold standard approach to improving a range of outcomes for frail older adults in acute hospitals. Research has demonstrated that it is feasible to embed CGA within the ED and a model of care delivered by interdisciplinary teams incorporating geriatric competencies into their service has been recommended to meet the emergency and urgent care needs of this patient population within the ED. Despite this recommendation, there is no compelling evidence that ED-CGAs are clinically effective at improving clinical and process outcomes.

An ED based interdisciplinary team aim to improve the quality of care and outcomes of older adults through delivery of a CGA. CGA is an intensive interdisciplinary intervention, which assesses an older adult in a holistic fashion incorporating medical, functional, physical and psychological process of care. The team compromises a senior registrar in Geriatric Medicine, specialist geriatric nurse, senior occupational therapist, senior physiotherapist, and senior medical social worker. The investigators propose to explore the clinical and process outcomes of older adults who receive an interdisciplinary ED-CGA over a period of six months after their initial ED attendance through the conduct of a prospective cohort study.

Study Type

Observational

Enrollment (Actual)

133

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Ireland
    • Munster
      • Limerick, Munster, Ireland
        • University of Limerick

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

73 years and older (Older Adult)

Accepts Healthy Volunteers

N/A

Sampling Method

Non-Probability Sample

Study Population

Older adults aged ≥ 65 years who screen positive for risk of adverse outcomes following ED attendance.

Description

Inclusion Criteria:

  • Aged ≥ 65 years;
  • Identification of Seniors at Risk score of ≥ 2;
  • Manchester Triage System category of 2 to 5;
  • Presenting with a medical complaint.

Exclusion Criteria:

  • Older adults who are deemed not to have capacity to provide informed consent;
  • Older adults who present to the ED outside of the operational working hours (Monday-Friday, 08:00-16:00) of the interdisciplinary ED-CGA team;
  • Older adults presenting with acute cardiac and/or neurological pathology;
  • Older adults presenting with injuries that require surgical intervention;
  • Older adults presenting with high illness acuity, which necessitates treatment in the resuscitation room for the duration of their ED stay.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of hospital admission from the ED index attendance.
Time Frame: 6 months
Number of participants who are admitted to hospital following their index ED attendance
6 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of functional decline (including functional decline at discharge from hospital among the cohort admitted from the ED).
Time Frame: 30 days and 6 months
Functional decline is defined as a net decrease in the number of activities of daily living performed independently as measured by the self-reported Barthel Index. The sum score of all subscales may range from 0-20 points, where 0 indicates the maximum level of dependency and 20 indicates maximum independence.
30 days and 6 months
Patient satisfaction with the ED index attendance
Time Frame: 30-day follow-up
Participants will rate their satisfaction across a number of domains using the 18-item Patient Satisfaction Questionnaire. The sum score of all subscales may range from 18 to 90 points, where 18 points is the poorest possible evaluation and 90 points the best.
30-day follow-up
Number of unscheduled ED re-attendances
Time Frame: 30 days and 6 months
Number of participants who experienced an unscheduled ED re-attendance following their index attendance
30 days and 6 months
Number of unscheduled hospital admissions
Time Frame: 30 days and 6 months
Number of participants who experienced an unscheduled hospital (re)admission following their ED index attendance
30 days and 6 months
Nursing home admission
Time Frame: 30 days and 6 months
Number of participants who were admitted to a nursing home or residential care facility following their ED index attendance
30 days and 6 months
Mortality
Time Frame: 30 days and 6 months
Number of participants who died following their ED index attendance
30 days and 6 months
Healthcare utilisation
Time Frame: 30 days and 6 months
Number and duration of services that participants were in receipt of following ED index attendance e.g. specialist geriatric ambulatory care hub attendances, GP visits, public health nurse visits, home care support, outpatient clinic attendance, health and social care professionals input etc.
30 days and 6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Limerick

Collaborators

University Hospital of Limerick

Investigators

  • Principal Investigator: Íde O'Shaughnessy, MSc, University of Limerick

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 1, 2022

Primary Completion (Actual)

August 5, 2022

Study Completion (Actual)

February 10, 2023

Study Registration Dates

First Submitted

February 12, 2022

First Submitted That Met QC Criteria

February 12, 2022

First Posted (Actual)

February 23, 2022

Study Record Updates

Last Update Posted (Actual)

June 22, 2023

Last Update Submitted That Met QC Criteria

June 20, 2023

Last Verified

June 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ED-CGA

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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