Geriatric screening and multidisciplinary assessment of older adults in the Emergency Department (ED) decrease hospitalizations and ED revisits. The impact on patient-reported outcomes of health-related quality of life (HRQoL) and functional status is not known. A hybrid type II implementation/effectiveness prospective cohort study was conducted in an academic ED. The intervention bundle was geriatric screening for delirium, fall risk, and transition of care needs, and multidisciplinary assessment. All older adults (≥ 65 years) placed in the ED observation unit were eligible. HRQoL and functional status were obtained at the ED visit, 30, and 90 days, and were compared between the pre- and post-intervention implementation cohorts. Secondary outcomes included ED revisits, falls, mortality, and intervention adoption measures. From 2019 to 2023, 368 adults participated in the study: Most were community-dwelling (97%) and had multiple comorbidities. The pre (n = 138) and post (n = 230) cohorts did not differ in baseline functional status or HRQoL. The rate of geriatric screening improved from 12.3% in the pre-implementation cohort to 91.3% in the post-implementation cohort (p < 0.01). Multispecialty consultation also increased (68.1%-91.3%, p < 0.01). The proportion who had a post-ED visit decline in functional status did not differ between cohorts. Physical HRQoL declined similarly in both cohorts (-0.73 vs. -0.33, p = 0.61) at 90 days. Mental HRQoL improved in both cohorts; improvement was greater in the pre-cohort (2.35 vs. 0.32, p = 0.02). ED revisits and re-hospitalizations were unchanged (30 days: 23.0% vs. 17.2%, p = 0.18, and 90 days: 37.8% vs. 34.8%, p = 0.57). The intervention decreased falls at 30 and 90 days (30 days: 9.7% vs. 3.2%, p = 0.04; 90 days: 22.1% vs. 7.9%, p < 0.01). Geriatric screening in the ED increased identification of geriatric syndromes and multidisciplinary consultation. The intervention was associated with decreased falls but did not affect HRQoL or reduce functional decline post ED visit. clinicaltrials.gov: NCT04068311.
Southerland et al. (Wed,) studied this question.
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