Alakare, J., Kemp, K., Strandberg, T. et al. Systematic geriatric assessment for older patients with frailty in the emergency department: a randomised controlled trial. BMC Geriatr 21, 408 (2021). https://doi.org/10.1186/s12877-021-02351-2
Systematic geriatric assessment for older patients with frailty in the emergency department : a randomised controlled trial
|Author:||Alakare, Janne1; Kemp, Kirsi1; Strandberg, Timo2,3;|
1Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, PL 340 |Haartmaninkatu 4, 00029 HUS, Helsinki, Finland
2University of Helsinki and Helsinki University Hospital, Helsinki, Finland
3Centre for Life Course Health Research, University of Oulu, Oulu, Finland
4Päijät-Häme Joint Authority for Health and Wellbeing, Services for Older People, Lahti, Finland
5Department of Internal Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
|Online Access:||PDF Full Text (PDF, 0.9 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2021102852749
|Publish Date:|| 2021-10-28
Background: Comprehensive 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.
Methods: We 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.
Results: A 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.
Conclusion: Systematic 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 registration: The trial was registered in the ClinicalTrials.gov (registration number and date NCT03751319 23/11/2018).
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
3121 General medicine, internal medicine and other clinical medicine
The trial was funded through state funding for university-level health research, granted by the Helsinki University Hospital, and the Department of Emergency Medicine and Services, Helsinki University Hospital. JA and KK received personal grants for the study from the Finnish Association for Emergency Medicine and the Finnish Medical Foundation. The funding bodies were not involved in the design of the study, collection, analysis, or interpretation of the data, or in writing the manuscript. No sponsors were involved in the trial.
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