Background: This study aimed to explore the process, clinical, and patient-reported outcomes of older adults who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the emergency department (ED) over a six-month period after their initial ED attendance.
Patients and Methods: A prospective cohort study recruited older adults aged ≥ 65 years who presented to the ED of a university teaching hospital in Ireland. Baseline assessment data comprising a battery of demographic variables and validated indices were obtained at the index ED attendance. Telephone interviews were completed with participants at 30- and 180-day follow-up. The primary outcome was incidence of hospital admission following the index ED attendance. Secondary outcomes included participant satisfaction, incidence of functional decline, health-related quality of life, incidence of unscheduled ED re-attendance(s), hospital (re)admission(s), nursing home admission, and death.
Results: A total of 133 participants (mean age 82.43 years, standard deviation = 6.89 years; 71.4% female) were recruited; 21.8% of the cohort were admitted to hospital following the index ED attendance with a significant decline in function reported at hospital discharge (Z = 2.97, p = 0.003). Incidence of 30- and 180-day unscheduled ED re-attendance was 10.5% and 24.8%, respectively. The outcome at the index ED attendance was a significant predictor of adverse outcomes whereby those who were discharged home had significantly lower odds of multiple adverse process outcomes at 30- and 180-day follow-up, and significantly higher function and health-related quality of life at 30-day follow-up.
Conclusion: While this study was observational in nature, findings suggest CGA in the ED may improve outcomes by mitigating against the adverse effects of potentially avoidable hospital admissions and focusing on a longitudinal approach to healthcare delivery at the primary-secondary care interface. Future research should be underpinned by an experimental study design to address key limitations in this study.



中文翻译：

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急诊科老年综合评估：过程、临床和患者报告结果的前瞻性队列研究


背景：本研究旨在探讨首次就诊后六个月内在急诊科 (ED) 接受跨学科综合老年评估 (CGA) 的老年人的过程、临床和患者报告的结果。

患者和方法：一项前瞻性队列研究招募了在爱尔兰一所大学教学医院急诊科就诊的年龄≥ 65 岁的老年人。基线评估数据包括一系列人口统计变量和经过验证的指数，是在急诊就诊指数中获得的。在 30 天和 180 天的随访中完成了对参与者的电话采访。主要结果是按照急诊就诊指数计算的住院发生率。次要结局包括参与者满意度、功能下降发生率、健康相关生活质量、计划外急诊再次就诊发生率、医院（重新）入院、疗养院入院和死亡。

结果：总共招募了 133 名参与者（平均年龄 82.43 岁，标准差 = 6.89 岁；71.4% 女性）； 21.8% 的队列患者在 ED 就诊指数后入院，出院时报告功能显着下降（Z = 2.97， p = 0.003）。 30 天和 180 天计划外急诊再次就诊的发生率分别为 10.5% 和 24.8%。急诊就诊率指数的结果是不良结果的重要预测因子，出院回家的患者在 30 天和 180 天的随访中出现多种不良过程结果的几率显着降低，并且功能和健康相关质量显着提高。 30天随访时的生活。

结论：虽然这项研究本质上是观察性的，但研究结果表明，急诊室的 CGA 可以通过减轻潜在可避免的住院治疗的不利影响并重点关注初级与二级护理界面的纵向医疗服务提供方法来改善结果。未来的研究应以实验研究设计为基础，以解决本研究的主要局限性。