Comprehensive Geriatric Assessment in the Emergency Department

NCT05252182 | Completed

• 1 other identifier: ED-CGA
• Study Type: observational
• Target: 133
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Frailty

Keywords

older adults; frailty; emergency department; comprehensive geriatric assessment

Outcome Measures

Primary Outcomes (1)

• Incidence of hospital admission from the ED index attendance.

  Number of participants who are admitted to hospital following their index ED attendance

  6 months

Secondary Outcomes (7)

• Incidence of functional decline (including functional decline at discharge from hospital among the cohort admitted from the ED).

  30 days and 6 months

• Patient satisfaction with the ED index attendance

  30-day follow-up

• Number of unscheduled ED re-attendances

  30 days and 6 months

• Number of unscheduled hospital admissions

  30 days and 6 months

• Nursing home admission

  30 days and 6 months

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Age Groups: Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

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

You may qualify if:

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

You may not qualify if:

• 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.

Sponsors & Collaborators

• University of Limerick: lead
• University Hospital of Limerick: collaborator

Study Sites (1)

University of Limerick

Limerick, Munster, Ireland

Location

Related Publications (15)

• MAHONEY FI, BARTHEL DW. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61-5. No abstract available.

  PMID: 14258950 BACKGROUND

• McCusker J, Bellavance F, Cardin S, Trepanier S, Verdon J, Ardman O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc. 1999 Oct;47(10):1229-37. doi: 10.1111/j.1532-5415.1999.tb05204.x.

  PMID: 10522957 BACKGROUND

• Mackway-Jones K ed: Emergency triage. London: BMJ Publishing Group. 1997.

  BACKGROUND

• Marshall GN, Hays RD: The Patient Satisfaction Questionnaire Short Form (PSQ-18). Santa Monica, CA: Rand; 1994.

  BACKGROUND

• Conroy SP, Turpin S. New horizons: urgent care for older people with frailty. Age Ageing. 2016 Sep;45(5):577-84. doi: 10.1093/ageing/afw135. Epub 2016 Aug 1.

  PMID: 27496917 BACKGROUND

• Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One. 2018 Aug 30;13(8):e0203316. doi: 10.1371/journal.pone.0203316. eCollection 2018.

  PMID: 30161242 BACKGROUND

• Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013 Mar 2;381(9868):752-62. doi: 10.1016/S0140-6736(12)62167-9. Epub 2013 Feb 8.

  PMID: 23395245 BACKGROUND

• Lowthian JA, McGinnes RA, Brand CA, Barker AL, Cameron PA. Discharging older patients from the emergency department effectively: a systematic review and meta-analysis. Age Ageing. 2015 Sep;44(5):761-70. doi: 10.1093/ageing/afv102. Epub 2015 Aug 10.

  PMID: 26265674 BACKGROUND

• Sanders AB, Witzke D, Jones JS, et al.: Principles of care and application of the geriatric emergency care model. In: Sanders AB, ed. Emergency Care of the Elder Person. St Louis: Beverly Cracom Publications, 1996; 59-93.

  BACKGROUND

• Vermeiren S, Vella-Azzopardi R, Beckwee D, Habbig AK, Scafoglieri A, Jansen B, Bautmans I; Gerontopole Brussels Study group. Frailty and the Prediction of Negative Health Outcomes: A Meta-Analysis. J Am Med Dir Assoc. 2016 Dec 1;17(12):1163.e1-1163.e17. doi: 10.1016/j.jamda.2016.09.010.

  PMID: 27886869 BACKGROUND

• Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, O'Neill D, Robinson D, Shepperd S. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017 Sep 12;9(9):CD006211. doi: 10.1002/14651858.CD006211.pub3.

  PMID: 28898390 BACKGROUND

• Conroy SP, Stevens T, Parker SG, Gladman JR. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: 'interface geriatrics'. Age Ageing. 2011 Jul;40(4):436-43. doi: 10.1093/ageing/afr060. Epub 2011 May 26.

  PMID: 21616954 BACKGROUND

• Conroy SP, Ansari K, Williams M, Laithwaite E, Teasdale B, Dawson J, Mason S, Banerjee J. A controlled evaluation of comprehensive geriatric assessment in the emergency department: the 'Emergency Frailty Unit'. Age Ageing. 2014 Jan;43(1):109-14. doi: 10.1093/ageing/aft087. Epub 2013 Jul 23.

  PMID: 23880143 BACKGROUND

• Harding S. Comprehensive geriatric assessment in the emergency department. Age Ageing. 2020 Oct 23;49(6):936-938. doi: 10.1093/ageing/afaa059.

  PMID: 32315396 BACKGROUND

• O'Shaughnessy I, Robinson K, O'Connor M, Conneely M, Steed F, Ryan D, Carey L, Shchetkovsky D, Shanahan E, Leahy A, Quinn C, Sheikhi A, Galvin R. Comprehensive geriatric assessment in the emergency department: A protocol for a prospective cohort study. HRB Open Res. 2022 Sep 14;5:26. doi: 10.12688/hrbopenres.13504.2. eCollection 2022.

  PMID: 36313054 DERIVED

MeSH Terms

Conditions

Frailty; Emergencies

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms; Disease Attributes

Study Officials

• Íde O'Shaughnessy, MSc

  University of Limerick

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: February 12, 2022
• First Posted: February 23, 2022
• Study Start: February 1, 2022
• Primary Completion: August 5, 2022
• Study Completion: February 10, 2023
• Last Updated: June 22, 2023

Record last verified: 2023-06

Locations

IE (1)