Comprehensive Geriatric Assessment in the Emergency Department

Abstract Background Hip fracture (HF) is a major challenge for healthcare systems in terms of increased costs and lengths of stay, and it has been estimated that by 2050, half of the projected 6.26 million global HFs will occur in Asia. Owing to the high morbidity and mortality associated with HF in elderly individuals, it is crucial to recognize at-risk elderly patients in the ED so that special precautions and preventive measures can be taken. While comprehensive geriatric assessment (CGA) has been shown to improve outcomes and prevent secondary fractures in elderly individuals with HF in outpatient settings, there is a lack of data to support the use of CGA in the emergency department (ED) to identify elderly Asian patients who are at risk of HF. Aim To identify the characteristics of elderly Asian patients in the ED who have an increased risk of HF via CGA. Methods A case-control study was conducted in the ED at Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from October 2018 to December 2019. Patients ≥75 years old with and without HF were compared using data obtained from CGAs conducted by trained nurses. Results A total of 85 HF patients (cases) and 680 non-HF patients were enrolled, among whom 85 non-HF control individuals (controls) were selected by simple random sampling. HF occurred more frequently in women and in patients with depressive symptoms. An association between decreased handgrip strength and HF risk, especially in men, was also identified (P < 0.001). The variables independently associated with the presence of HF in the multivariate analysis were female sex (odds ratio (OR) = 2.937; 95% CI = 1.519-5.677) and decreased handgrip strength (OR = 3.739; 95% CI = 1.641-8.519). Conclusions By performing CGAs in the ED, we found that female sex and decreased handgrip strength were associated with HF risk. Therefore, we propose that targeted assessment of handgrip strength in female patients aged ≥75 years in the ED may identify those at greatest risk of HF, resulting in improved emergency care for geriatric patients.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116164 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6164

Author(s):

Cheng-Fu Lin ◽

Po-Chen Lin ◽

Sung-Yuan Hu ◽

Yu-Tse Tsan ◽

Wei-Kai Liao ◽

...

Keyword(s):

Emergency Department ◽

Older People ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Multivariate Regression ◽

Multivariate Regression Analysis ◽

Intervention Period ◽

Frailty Phenotype ◽

Admission Rates

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.

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185 Revisiting Comprehensive Geriatric Assessment in the Emergency Department

Age and Ageing ◽

10.1093/ageing/afz103.108 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Lucinda Edge ◽

Brian O'Rourke ◽

Conal Cunningham ◽

Frances Horgan

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Grip Strength ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Interdisciplinary Team ◽

Community Services ◽

Functional Mobility ◽

Calf Circumference ◽

The Past

Abstract Background In a large teaching hospital, a specialist interdisciplinary team identify frailty and begin comprehensive geriatric assessment of older adults in the Emergency Department (ED). This study aimed to determine the clinical utility of a range of measures: grip strength, calf circumference, frailty and functional mobility to evaluate whether they help to estimate the care pathways for patients. Objectives included: (1) To ascertain the prevalence of frailty and (2) To profile this population’s demographics, falls history, calf circumference and grip strength. Methods This was a cross-sectional study. Inclusion criteria were persons ≥ 70 who presented to ED weekdays during research hours 9:00 – 16:00, with Manchester triage score ≥ 3. Information on gait aids, social supports and falls in the past 6 months was self-reported. Grip strength was assessed using hydraulic hand-held dynamometry. Sarcopenia was measured using calf circumference as a proxy. Frailty was determined using the Clinical Frailty Scale (CFS). Functional mobility was assessed by an interdisciplinary team member. Onward referrals and admission to hospital were recorded. Data was analysed using SPSS statistics software. Results One hundred and one participants were included, 39 male (38.6%) and 62 female (61.4%), mean age 79.3 years. Thirty-five percent (n=36) were considered Frail (a CFS score of ≥5), 35.6% (n=36) lived alone, 52.5% (n=53) used a gait aid. Outcomes included admission to hospital (27.7%, n=28) and discharge with onward referral (25.7%, n=26). The most common referral was community physiotherapy (11.9%, n=12). The population identified as frail were more likely to be female (p = 0.036), to use a gait aid (p = 0.001) and to have fallen within the past 6 months (p = 0.007). Conclusion The prevalence of frailty was determined in this population and was not significantly associated with hospital admission, grip strength or calf circumference. A focus on alternative pathways to hospital admission with appropriate access to community services is recommended for individuals with frailty.

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