Abstract
Introduction:
Older people represent between 21 to 40% of Emergency Department (ED) users and proportionally use more ED services than any other age group. A Geriatric Ambulatory care service, in collaboration with Emergency Department, was initiated to achieve earlier identification and interventions for frail patients with geriatric syndromes.
Methodology:
Retrospective review was undertaken from 13th January 2022 until 23rd December 2022 in older patients discharged from the ED ambulatory area following a targeted geriatric assessment and recommended follow-up interventions at the geriatric clinic or day hospital. Two groups were identified, those compliant to follow-up interventions (GpC) and those that defaulted (GpD).
Demographic information, functional ability, hospital utilisation and mortality (up to one year), and any post-visit fragility fractures were reviewed. Data collection included identification of osteoporosis or osteopenia and cognitive decline during or following the visit and findings were compared across the 2 groups. Odd Ratios (ORs) with 95% Confidence Intervals (CIs) are provided as appropriate. All statistical analyses were performed using a two-tailed test with a significance level of p<0.05.
Results:
137 patients were reviewed, and 79 patients (58%) compliant to geriatric follow-up (GpC) and 58 patients (42%) non-compliant (GpD). Age and sex were similar, 80 vs 80 years, range 65-98 years and female s 58% vs 62%. BADL was 16.98 vs 18.42, range 4-20 and iADL 4.48 vs 5.02, range 0-7.
ED 7-day re-attendances were similar, 9% vs 12%, p=0.578 but 30-day hospital admissions were lower 10% vs 16%, p=.434, although 1 year ED attendances were higher in the compliant group, 56% vs 45%, p=0.230, which did not translate to more 1 year hospital admissions 35% vs 36%, p=1.000. Mortality was 12% vs 16%, p=.611.
More patients were identified as having osteoporosis 23% vs 21% or high-risk osteopenia 14% vs 9%, p=<001 and a larger number of patients had unevaluated bone health in the non-compliant group 27% vs 47%, p=<0.001. However, fragility fractures were similar, 9% vs 7%, p=0.758. AMT was 7.94 vs 5.02, range 0-10 and cognitive impairment identified in 43% vs 33%, p=0.001, with dementia in 28% vs 10%, p=.0001, Mild Cognitive Impairment in 15% vs 7%, p=.000.1 and suspected but not evaluated in 0% vs 12%, p=0.001