Reference: June 2025 | Issue 6 | Vol 11 | Page 13
Older patients living with frailty who receive a comprehensive geriatrician-led assessment (CGA) on presentation to the emergency department (ED) have considerably better outcomes and lower rates of nursing home admissions, a team of researchers from University Hospital Limerick (UHL) and the University of Limerick has found.
The randomised, controlled SOLAR trial enrolled older adults (≥75 years) who presented to the ED at UHL with medical complaints between November 9, 2020, and May 13, 2021, and who screened positive for frailty on the Identification of Seniors at Risk (ISAR) screening tool.
Patients requiring resuscitation as well as those with Covid-19, psychiatric, surgical, or trauma complaints were excluded. Outcome assessors were masked to treatment allocation.
A total of 228 patients were recruited, of whom 113 participants were included in the intervention group (CGA), and 115 in the control group (usual care). The average age of the patients was 84.
The results of the trial, published in Lancet Healthy Longevity, showed that CGA significantly reduced the length of time spent in the ED. In the intervention group, the median time in the ED was 11.5 hours (IQR 5-27) compared to 20 hours (7-29) in the control group.
The median difference (using the Hodges–Lehmann estimator) was 3.1 hours (95% CI 0.6-7.5; p=0·013). There were no adverse events related to the intervention.
CGA was also associated with lower rates of nursing home admission. Only one (1 per cent) of 102 patients in the intervention group was admitted to a nursing home, compared with nine (9 per cent) of 102 in the control group.
The intervention group reported greater increases in quality of life and lower decreases in function at both 30 days and 180 days. Hospital admissions and ED re-attendance rates were lower in the intervention group.
Commenting on the findings, lead investigator for the SOLAR trial, Dr Aoife Leahy, Consultant Geriatrician at UHL and HSE Mid West, said: “Early identification of a holistic range of issues allows clinicians to intervene at an earlier stage.
“Improved communication by the intervention team with the patient and families allowed patients to have greater agency and to advocate for themselves going forward. And the referrals organised by the team allowed the community services to proactively follow up patients on discharge.”
She said the positive results of the SOLAR trial should “inform how we structure services for older patients who present to our emergency departments. A significant number of patients and staff were involved in the trial and that involved significant changes in processes where patients got senior decision-making from the very start. The task for us now is to take these findings and examine how they can be implemented in a more sustainable way.”
Reference
Leahy A, Barry L, et al. Frailty screening with comprehensive geriatrician-led multidisciplinary assessment for older adults during emergency hospital attendance in Ireland (SOLAR): a randomised controlled trial. Lancet Healthy Longev 2024; 5(1): 100642
