The Establishment of Geriatric Multidisciplinary Service (GEMS) for the Identification and Management of Frailty and Delirium in Emergency Care

Abstract Background In Ireland the number of people aged 75 and over has grown by greater than 20% in recent years, as a consequence increasing numbers of older adults are presenting to emergency departments. Frailty is a multi-factorial syndrome that diminishes body reserves and impacts on the person's ability to respond to stressors, such as illness or trauma. In October 2023, a Consultant Geriatrician lead GEMS was launched to identify, assess and manage frailty and associated syndromes, this study concentrated on delirium. Methods All patients 75 and older are triaged by GEMS using an electronic IPM System against prioritisation inclusion and exclusion criteria, utilising a case management approach and Rockwood Clinical Frailty Scale to screen for frailty. CFS score 1 to 3 is fit and managing well, alternatively a CFS of 4 or greater initiates a Comprehensive Geriatric Assessment. A 4AT assessment identifies patients at risk and screening for delirium. Results The results demonstrate a total of 744 patients were reviewed by GEMS from Jan - April 2024, 67% (n=503) had a CGA completed and 72% (n=537) of the population sample are living with frailty. A CFS7 (n=121), CFS8 (n=15) and CFS9 (n=3) are severely frail 26% and moderate frailty CFS6 (n=149) 28%. The 4AT results identified 10% of patients had a positive delirium score (n=60). In addition, a total of (n=61) patients had a formal diagnosis of dementia of which (n=12) patients had a positive 4AT. Conclusion The data confirms the prevalence of frailty in emergency care is approximately 70% and the incidence of acute delirium is approximately 10%. These indicators significantly impact on outcomes of care and treatment plans. Therefore, substantiates the need for early identification of frailty and delirium and the requirement for a highly specialised Consultant Geriatrician Lead (GEM) Service to ensure patients are on the right journey.