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Elderly/Long-term Care

Performing a geriatric assessment of elderly patients in the ER can reduce later nursing home admissions

Up to 18 percent of patients seen in hospital emergency departments (EDs) are aged 65 or older. When elderly patients arrive at the ED, they usually have complex medical needs and limited social support. In fact, these emergency visits typically signal increased frailty, decline, and likelihood of institutionalization.

Providing elderly ED patients with a comprehensive geriatric assessment by a nurse specially trained in geriatrics and subsequent referral to a community or social agency, primary care provider, and/or geriatric clinic, can reduce subsequent nursing home admissions. This is especially true for high-risk elderly patients, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS09725).

A research team led by Robert M. Palmer, M.D., M.P.H., and Lorraine Mion, R.N., Ph.D., randomized 326 elderly ED patients to geriatric assessment and 324 to usual care at one of two urban hospital EDs that served predominantly indigent and minority patients. The geriatric nurse who conducted the geriatric assessment was also in charge of discharge planning and referrals to the appropriate medical or social agency. The researchers assessed ED use, hospitalization, and nursing home admission at 30 and 120 days after an ED visit.

Overall hospital use was similar between the two groups at 30 and 120 days after the index ED visit. However, geriatric assessment patients were less likely to have gone to a nursing home than usual care patients (0.7 vs. 3 percent) a month later, and they were far more likely to have been referred to a community agency (56 vs. 1 percent). Among the high-risk elderly, the geriatric assessment group had fewer hospital days than the usual care group (0.6 vs. 1.6) and fewer nursing home admissions (2 vs. 7 percent) at 30 days and 120 days (3 vs. 10 percent). The researchers caution that the lack of nurse followup of referrals might have weakened the effect of geriatric assessment in this study.

More details are in "Case finding and referral model for emergency department elders: A randomized clinical trial," by Lorraine C. Mion, Ph.D., R.N., Dr. Palmer, Stephen W. Meldon, M.D., and others, in the January 2003 Annals of Emergency Medicine 41(1), pp. 57-68.

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