Comprehensive Geriatric Assessment and Clinical Outcomes in the Older People at the Emergency Department

Cheng-Fu Lin, Po-Chen Lin, Sung-Yuan Hu, Yu-Tse Tsan, Wei-Kai Liao, Shih-Yi Lin and Tzu-Chieh Lin
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Cheng-Fu Lin: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Po-Chen Lin: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Sung-Yuan Hu: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Yu-Tse Tsan: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Wei-Kai Liao: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Shih-Yi Lin: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Tzu-Chieh Lin: Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan

IJERPH, 2021, vol. 18, issue 11, 1-13

Abstract: Visits by older people to the Emergency Department (ED) have increased in recent decades with higher revisiting and admission rates after discharge, particularly for those with frailties. This study used a before–after design aimed at evaluating Comprehensive Geriatric Assessment (CGA) screening in older ED patients (aged ? 75 years) during the 12-month preintervention period. Additionally, a CGA-based structured follow-up program after ED discharge was executed during the next 12-month intervention period. Amongst the 358 participants (median age 82 years), involving 122 in the preintervention period and 236 in the intervention period, 77 participants (21.5%) were identified as pre-frailty, while 274 (76.5%) were identified as frail using the Fried frailty phenotype. One-hundred ten (110) (30.7%) patients revisited the ED with 73 (20.4%) being admitted and 20 (5.6%) dying within three months after ED discharge. Compared with preintervention and intervention period, it was shown that the rates of admission at the index ED visit (50.8% vs. 23.1%), and mortality (10.7% vs. 3.0%), were both were significantly reduced. Using multivariate regression analysis, it was shown frailty was significantly associated with three-month mortality after adjusting for potential confounders. On the contrary, the program significantly decreased admission and death rate. It is suggested that frailty was prevalent amongst the older ED patients, and should be screened for in order to decrease revisits/admissions after ED discharge.

Keywords: older people; acute care; emergency department; geriatric assessment; frailty (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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