Emergency Department Interventions for Frailty: early geriatric intervention to reduce potentially avoidable acute hospital admissions

• Published in: Asian journal of gerontology and geriatrics Vol. 15; no. 2; pp. 102 - 103
• Main Author: Chong, E
• Format: Journal Article
• Language: English
• Published: Hong Kong Hong Kong Academy of Medicine 01.12.2020
• Subjects: Frailty; Geriatrics; Hospitalization; Older people
• ISSN: 1819-1576

Background: The Emergency Department Interventions for Frailty (EDIFY) programme provides early geriatric interventions at the emergency department to reduce acute admissions by identifying patients for discharge or transfer to low-acuity care facilities. We aimed to evaluate the effect of EDIFY on reducing potentially avoidable acute hospitalisations. Methods: This quasi-experimental study evaluated EDIFY versus standard care. Older persons presenting to the emergency department with plans for acute admission were recruited. Data on demographics, premorbid function, frailty status (measured by the Clinical Frailty Scale), comorbidities, and illness severity were recorded. The two groups were compared in terms of successful acute admission avoidance (which was defined as no emergency department attendance within 72 hours of discharge, no transfer to an acute ward from subacute wards within 72 hours, or no transfer to an acute ward from the short-stay unit), hospitalisation, institutionalisation, functional decline, mortality, and frailty transitions. Results: We recruited 66 female and 34 male participants (mean age, 90.0±4.1 years). The EDIFY (n=43) and standard care (n=57) groups were comparable in terms of baseline characteristics. 36 (83.7%) participants in the EDIFY group successfully avoided acute hospitalisation (20.9% to home, 23.3% to subacute care, and 44.2% to short-stay unit), whereas all participants in the standard care group were hospitalised. At 6 months, participants in the EDIFY group had lower mortality (4.8% vs 19.3%, p=0.034) and lower transition to higher Clinical Frailty Scale scores (difference: 0.50±0.71 vs 1.08±1.09, p<0.010). Conclusion: Early geriatric interventions at the emergency department of acute hospitals can reduce acute hospitalisations and improve 6-month outcomes among older adults presenting to the emergency department.