Systematic geriatric assessment for older patients with frailty in the emergency department: a randomised controlled trial

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Alakare , J , Kemp , K M , Strandberg , T , Castren , M , Jakovljevic , D , Tolonen , J P & Harjola , V-P 2021 , ' Systematic geriatric assessment for older patients with frailty in the emergency department: a randomised controlled trial ' , BMC Geriatrics , vol. 21 , no. 1 , 408 . https://doi.org/10.1186/s12877-021-02351-2

Title: Systematic geriatric assessment for older patients with frailty in the emergency department: a randomised controlled trial
Author: Alakare, Janne; Kemp, Kirsi Maria; Strandberg, Timo; Castren, Maaret; Jakovljevic, Dimitrije; Tolonen, Jukka Petri; Harjola, Veli-Pekka
Contributor organization: Department of Diagnostics and Therapeutics
HUS Emergency Medicine and Services
HUS Internal Medicine and Rehabilitation
Timo Strandberg / Principal Investigator
Department of Medicine
Clinicum
Fysikaalisen lääketieteen osasto
Date: 2021-07-02
Language: eng
Number of pages: 11
Belongs to series: BMC Geriatrics
ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-021-02351-2
URI: http://hdl.handle.net/10138/340488
Abstract: BackgroundComprehensive geriatric assessment provided in hospital wards in frail patients admitted to hospital has been shown to reduce mortality and increase the likelihood of living at home later. Systematic geriatric assessment provided in emergency departments (ED) may be effective for reducing days in hospital and unnecessary hospital admissions, but this has not yet been proven in randomised trials.MethodsWe conducted a single-centre, randomised controlled trial with a parallel-group, superiority design in an academic hospital ED.ED patients aged >= 75 years who were frail, or at risk of frailty, as defined by the Clinical Frailty Scale, were included in the trial. Patients were recruited during the period between December 11, 2018 and June 7, 2019, and followed up for 365 days.For the intervention group, systematic geriatric assessment was added to their standard care in the ED, whereas the control group received standard care only.The primary outcome was cumulative hospital stay during 365-day follow-up. The secondary outcomes included: admission rate from the index visit, total hospital admissions, ED-readmissions, proportion of patients living at home at 365 days, 365-day mortality, and fall-related ED-visits.ResultsA total of 432 patients, 63% female, with median age of 85 years, formed the analytic sample of 213 patients in the intervention group and 219 patients in the control group.Cumulative hospital stay during one-year follow-up as rate per 100 person-years for the intervention and control groups were: 3470 and 3149 days, respectively, with rate ratio of 1.10 (95% confidence interval, 0.55-2.19, P=.78). Admission rates to hospital wards from the index ED visit for the intervention and control groups were: 62 and 70%, respectively (P=.10). No significant differences were observed between the groups for any outcomes.ConclusionSystematic geriatric assessment for older adults with frailty in the ED did not reduce hospital stay during one-year follow-up. No statistically significant difference was observed for any secondary outcomes. More coordinated, continuous interventions should be tested for potential benefits in long-term outcomes.Trial registrationThe trial was registered in the ClinicalTrials.gov (registration number and date NCT03751319 23/11/2018).
Subject: 80 and over
ADULTS
Aged
ELDERS
Emergency Departments
Frailty
Geriatric Assessment
INTERVENTION
Length of Stay
PEOPLE
RISK
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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