Comprehensive geriatric assessment measures and subsequent EMS-transported emergency department use in adults aged ≥ 80 years: a retrospective cohort study

BACKGROUND: Emergency Medical Services (EMS) ambulance transport is a common route of emergency department (ED) arrival for adults aged ≥ 80 years, but factors associated with future EMS-transported ED presentation remain uncertain. We assessed whether baseline comprehensive geriatric assessment (CGA) measures were associated with EMS-transported ED presentation within 12 months. METHODS: We performed a retrospective cohort study in Türkiye linking the Healthy Aging Center (YAŞAM) CGA registry, which records routine multidomain geriatric assessments in community-dwelling older adults, to ED administrative records from a tertiary hospital. Consecutive adults aged ≥ 80 years who underwent baseline CGA between October 5, 2023 and December 10, 2024 were included (n = 587). The primary outcome was ≥ 1 EMS-transported ED presentation within 12 months; repeat use (≥ 2 presentations) was a prespecified secondary outcome. Separate age- and sex-adjusted domain-specific association logistic regression models were fitted for each CGA measure; exploratory age- and sex-adjusted logistic models were also used for repeat use. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Cause-specific Cox models were used as sensitivity analyses for time to first EMS-transported ED presentation, censoring at death before any EMS event. RESULTS: During follow-up, 159/587 participants (27.1%) had ≥ 1 EMS-transported ED presentation, 55/587 (9.4%) had repeat use, and 51/587 (8.7%) died. Higher frailty was associated with the primary outcome (odds ratio [OR] per 1-point increase, 1.30; 95% confidence interval [CI], 1.16–1.47), whereas higher Katz Activities of Daily Living scores (OR, 0.77; 95% CI, 0.70–0.85), Mini Nutritional Assessment-Short Form scores (OR, 0.85; 95% CI, 0.80–0.92), and Timed Up and Go indicator = 1 (OR, 0.34; 95% CI, 0.23–0.50) were associated with lower odds. Discrimination was modest across models (AUC, 0.575–0.643). Cause-specific Cox sensitivity analyses showed directionally similar associations. CONCLUSIONS: In adults aged ≥ 80 years, multiple routinely collected CGA domains were associated with subsequent EMS-transported ED use. These measures should be interpreted as indicators of geriatric vulnerability rather than stand-alone predictive tools; any predictive application would require externally validated multivariable models.