BACKGROUND AND AIMS: Comprehensive geriatric assessment (CGA) may benefit frail or chronically ill patients in the emergency department (ED), but take too much time to be performed routinely in ED. An alternative approach is to use first a screening tool to detect high-risk patients and then perform CGA in these patients only. This systematic review focuses on the use and value of CGA in ED for evaluation of older patients and its influence on adverse outcomes. This approach is compared with an alternative one using existing screening tools, validated in ED, to detect high-risk patients needing subsequent CGA. This review ends by suggesting a short assessment of CGA to be used in ED and ways to improve home discharge management from ED. METHODS: A systematic English Medline literature search was conducted in December 2009, with no date limit with the following Medical Subject Heading (MeSH) terms: "Frail Elderly", "Health Services for Aged", "Community Health Nursing", "Emergency Service, Hospital", "Geriatric Assessment", "Patient Discharge", "Risk Assessment" and "Triage". RESULTS: We selected 8 studies on CGA efficiency and 14 on screening tools. CGA in ED is efficient for decreasing functional decline, ED readmission and possibly nursing home admission in high-risk patients. As CGA takes too much time to be performed routinely in ED, validated screening tools can be applied to detect high-risk patients who will benefit most from CGA. CONCLUSIONS: The selected studies demonstrated that screening of high-risk patients is more efficient than age-based screening, and that CGA performed in ED, followed by appropriate interventions, improves outcomes.
BACKGROUND AND AIMS: Comprehensive geriatric assessment (CGA) may benefit frail or chronically ill patients in the emergency department (ED), but take too much time to be performed routinely in ED. An alternative approach is to use first a screening tool to detect high-risk patients and then perform CGA in these patients only. This systematic review focuses on the use and value of CGA in ED for evaluation of older patients and its influence on adverse outcomes. This approach is compared with an alternative one using existing screening tools, validated in ED, to detect high-risk patients needing subsequent CGA. This review ends by suggesting a short assessment of CGA to be used in ED and ways to improve home discharge management from ED. METHODS: A systematic English Medline literature search was conducted in December 2009, with no date limit with the following Medical Subject Heading (MeSH) terms: "Frail Elderly", "Health Services for Aged", "Community Health Nursing", "Emergency Service, Hospital", "Geriatric Assessment", "Patient Discharge", "Risk Assessment" and "Triage". RESULTS: We selected 8 studies on CGA efficiency and 14 on screening tools. CGA in ED is efficient for decreasing functional decline, ED readmission and possibly nursing home admission in high-risk patients. As CGA takes too much time to be performed routinely in ED, validated screening tools can be applied to detect high-risk patients who will benefit most from CGA. CONCLUSIONS: The selected studies demonstrated that screening of high-risk patients is more efficient than age-based screening, and that CGA performed in ED, followed by appropriate interventions, improves outcomes.
Authors: M J R Aliberti; K E Covinsky; D Apolinario; S J Lee; S Q Fortes-Filho; J A Melo; S S C Viana; C K Suemoto; W Jacob-Filho Journal: J Nutr Health Aging Date: 2019 Impact factor: 4.075
Authors: Lauren T Southerland; Alexander X Lo; Kevin Biese; Glenn Arendts; Jay Banerjee; Ula Hwang; Scott Dresden; Vivian Argento; Maura Kennedy; Christina L Shenvi; Christopher R Carpenter Journal: Ann Emerg Med Date: 2019-11-13 Impact factor: 5.721
Authors: S Q Fortes-Filho; M J R Aliberti; D Apolinario; J A Melo-Fortes; M C Sitta; W Jacob-Filho; L E Garcez-Leme Journal: J Nutr Health Aging Date: 2020 Impact factor: 4.075
Authors: Mieke Deschodt; Els Devriendt; Marc Sabbe; Daniel Knockaert; Peter Deboutte; Steven Boonen; Johan Flamaing; Koen Milisen Journal: BMC Geriatr Date: 2015-04-26 Impact factor: 3.921