A Prospective Cohort Study of Clinical and Process Outcomes of Older Adults That Transition Through the Geriatric Emergency Medicine Unit(GEM-U)

A Prospective Cohort Study of the Clinical and Process Outcomes of Older Adults That Transition Through the Geriatric Emergency Medicine Unit (GEM-U)

This study will characterise the patients using the Geriatric Emergency Medicine Unit, a unit which provides specialist care for patients aged 75 years and older attending the emergency department. It will examine how this specialist care impacts their health in terms of a number of different outcomes, such as; function, quality of life and health care usage; for example admission to the acute hospital.

Study Overview

• Status: Recruiting
• Conditions: Frailty

Detailed Description

The emergency department is a particularly challenging and busy environment, particularly for older adults living with frailty. It is widely acknowledged throughout the literature and national healthcare strategy that these older adults require holistic, person centred care that targets the intricacies of multifaceted, complex health issues.

The geriatric emergency medicine unit (GEM-U) aims to provide such care through the framework of comprehensive geriatric assessment, with in-put from a team of healthcare disciplines. The main aim of this study is to look at how this specialist care impacts patient outcomes, such as acute admission. Clinical and process outcomes of participants will be examined using patient reported outcome measures, which will include;

1. Global measure of function (Barthel Index)
2. Delirium screen (4AT +/- Delirium Rating Scale)*
3. Frailty status (Clinical Frailty Scale)
4. Nutritional status (Mini Nutritional Assesment)
5. Quality of life (EuroQoL-5D-5L).
6. Patient satisfaction (PSQ-18).

Participants will be followed at 30 days and 6 months post recruitment. All participants will give fully informed consent. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) standardised reporting guidelines will be followed in the conduct and reporting of this research. Data will be statistically analysed

• Study Type: Observational
• Enrollment (Estimated): 150

Contacts and Locations

• Study Contact: Name: Ida M Carroll, MSc; Phone Number: 061482119 0860638269; Email: 09006791@studentmail.ul.ie
• Study Contact Backup: Name: Rose Galvin; Phone Number: 0868463842; Email: rose.galvin@ul.ie

Study Locations

• Ireland
  • Munster
    • Limerick, Munster, Ireland, V94 F858
      • Recruiting
      • University Hospital Limerick
      • Contact: Rose Galvin; Phone Number: 0868463842; Email: rose.galvin@ul.ie
      • Contact: Ida Carroll; Phone Number: 0860638269; Email: 09006791@studentmail.ul.ie

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

All prospective older adults attending the GEMU that meet inclusion criteria will be invited to participate. However, this will be limited to the working hours of the research team (Monday-Friday, 8:00-20:00).

Description

Inclusion Criteria:

• Older adults aged ≥75 years
• Manchester Triage System category 2-5
• Screen positive for risk of adverse outcomes after ED visit (≥ 2 on ISAR screening tool)
• Presenting with a medical condition
• Reviewed by the Older Persons Integrated Care Team

Exclusion Criteria:

• Patients presenting with a non-medical issue including major trauma or hip fracture

  • Patients presenting with acute stroke or transient ischaemic attack
  • Patients more appropriate to another alternative pathway e.g. deep vein thrombosis pathway, low risk chest pain pathway
  • Patients with acute coronary syndrome or unstable arrthymia
  • Patients requiring care in the resuscitation room
  • Patients with head injury (unless appropriate assessment and management has been fully completed by ED team)
  • Patients with possible spinal injury (unless appropriate assessment and management has been fully completed by ED/orthopaedic team)
  • Patients with low Glasgow Coma Scale
  • Other exclusions at the discretion of the Older Persons Integrated Care team depending on team capacity and expertise
  • Exclusion criteria as set out above, are in line with those set out in the UHL Operating Policy of the Older Persons Integrated Care Team.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Our primary outcome is incidence of hospital admission at index GEM-U presentation	Patients who attend GEM-U and have an acute hospital admission at this time	Patients are followed at 30 days and 6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mortality	Mortality	Patients are followed at 30 days and 6 months
Unscheduled ED revisit	Patients who attend the ED department again during the follow up period	Patients are followed at 30 days and 6 months
Unscheduled hospital visit(s)	Patients who have unplanned hospital admission (i.e. not elective procedure) during follow up period	Patients are followed at 30 days and 6 months
Nursing home admission	Patients now living in a nursing home	Patients are followed at 30 days and 6 months
Healthcare utilization (GP visit, out-patient geriatric services, PHN visit, HSCP services)	Use of primary care and community care services	Patients are followed at 30 days and 6 months

Collaborators and Investigators

• Sponsor: University of Limerick
• Investigators: Principal Investigator: Ida Carroll, University of Limerick

Study record dates

Study Major Dates

• Study Start (Actual): February 10, 2025
• Primary Completion (Estimated): March 30, 2026
• Study Completion (Estimated): March 30, 2026

Study Registration Dates

• First Submitted: November 14, 2025
• First Submitted That Met QC Criteria: November 14, 2025
• First Posted (Actual): November 19, 2025

Study Record Updates

• Last Update Posted (Actual): November 19, 2025
• Last Update Submitted That Met QC Criteria: November 14, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Comprehensive Geriatric Assessment
• Additional Relevant MeSH Terms: Pathologic Processes; Pathological Conditions, Signs and Symptoms; Frailty
• Other Study ID Numbers: GEM-U2025

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No