Unexpected Journeys: Investigating Urgent and Emergency Care Trends of Patients Attending a Community Specialist Team for Older Adults

• Published in: Age and ageing 2024-09, Vol.53 (Supplement_4)
• Main Authors: Chan, Kei Yen, Geoghegan, James, McCleane, Fiona, Fitzmaurice, Cliodhna, Mannion, Karen, Neachtain, Maire Ni, Shiel, Edel, Donohue, Mary, Mulligan, Des, Ramjohn, Joshua, Lyne, Maria Louise, Al Fazari, Afrah, Reddin, Catriona, McDermott, Clodagh, Stankard, Aidan, Burke, Shona, Lynch, Amy, Hanrahan, Caoimhe, Higgins, Meave, Memon, Sajjan, Murphy, Dearbhla Edwards, Conlon, Chloe, Okon, Mary, Cashen, Aoife, Martin, Niamh, Small, Cliona, Robinson, Stephanie, Costello, Maria, Canavan, Michelle
• Format: Article
• Language: English
• Subjects: Aging; Attendance; Barthel Index; Beds; Case management; Clinical assessment; Emergency medical care; Emergency services; Functional status; Geriatric assessment; Geriatrics; Health care; Health services utilization; Hospitalization; Integrated care; Nursing homes; Older people; Patient admissions; Patient-centered care; Patients; Quality of care; Rehabilitation; Surgery; Teams
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afae178.347

Abstract Background Transitions of care for older people via ICPOP and Urgent and Emergency Care (UEC) pathways are becoming more complex. Demand for unscheduled care for older adults with complex care needs will increase with an ageing society, requiring proactive case management and practical realisation of integrated care pathways. Methods Retrospective analysis of UEC presentations of older patients attending a community specialist team (CST) who underwent Comprehensive Geriatric Assessment (CGA) between January-July 2023. Demographics and functional status [Clinical Frailty Score (CFS), Barthel Index (BI), Lawton-Brody Score (IADL), Montreal Cognitive Assessment (MOCA)] were extracted, along with UEC presentations post-CGA until March 2024. Results 356 patients underwent CGA and 42% (n=148) had subsequent unscheduled care attendance(s). Of those with an UEC attendance 36% (n=54) lived alone. Median functional scores were: CFS 5, BI 17, IADL 3, MOCA 17. Median time to UEC presentation was 100 days since CGA. There were 283 UEC interactions in total. 39% (n=58) had >1 interaction. 73% (n=206) of interactions resulted in acute hospital admissions, 21% (n=58) were ED visits, and 6% (n=19) were Pathfinder interactions. Falls (31%) and infection (19%) were the leading causes for presentation. Of 206 admissions, 61% were admitted under medical specialties, 26% under Geriatric Medicine, and 13% under Surgery. Average hospital stay was 13 days. 65% (n=134), were discharged home, 11% (n=22) to transitional care beds, 7% (n=15) to rehabilitation, 7% (n=14) to nursing home, 3% (n=5) transferred to other hospitals, 7%(n=15) died. Conclusion Over half of patients attending a CST had an UEC presentation, reflecting the complexity of this cohort and their level of healthcare utilisation. Case management roles that complement and pull together existing elements of the older persons pathway are lacking across healthcare settings and are fundamental to successful implementation of a patient-centred age friendly health system.