Research finds benefits for older patients who receive comprehensive geriatric assessment in ED

Pictured outside the Emergency Department at UHL for results of the SOLAR Trial study published in the Lancet were Íde O’Shaughnessy, clinical specialist occupational therapist; Prof Margaret O’Connor, consultant in geriatric and general internal medicine; Dr Aoife Leahy, consultant geriatrician; Brian Moran, senior physiotherapist; and Dr Louise Barry, School of Nursing and Midwifery, University of Limerick

SOLAR Trial research finds significant benefits for older patients who receive comprehensive geriatric assessment in ED

Older patients living with frailty who receive comprehensive geriatrician-led multidisciplinary assessment on presenting to the Emergency Department (ED) have considerably better experiences and outcomes, a team of researchers from University Hospital Limerick (UHL) and the University of Limerick has found.

The results of the SOLAR trial have been published in Lancet Healthy Longevity and the study was highly commended having recently been shortlisted for Research Paper of the Year at the Irish Healthcare Awards 2024. The principal investigators were Prof Rose Galvin and Prof Margaret O’Connor, and the lead investigator is Dr Aoife Leahy.

Among the benefits for older patients who participated in the trial were reduced waiting times in ED, fewer hospital admissions, lower rates of ED re-attendance and fewer nursing home admissions. Patients also reported better quality of life and function at 180 days.

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Over 200 patients aged 75 and over who presented with medical complaints to the ED at UHL between November 2020 and April 2021 were enrolled in the randomised controlled trial. The average age of the patients was 84.

All patients were screened for frailty, with one group receiving comprehensive geriatric assessment (CGA) while still in ED or AMAU. The benefits of CGA on acute geriatric wards are proven but the Limerick-based researchers found little published evidence on the effectiveness of this intervention for the increasing numbers of older patients living with frailty presenting to our emergency departments. Of the approximately 80,000 patients who have presented to the ED at UHL in the year to date (December 1st), over 15 per cent were aged 75 and older.

During the trial, patients received a geriatrician-led multidisciplinary holistic assessment while still in ED or AMAU. This involved management of the patient’s presenting complaint, a falls review, cognitive assessment, medication review by a pharmacist, bone health assessment and social and environmental assessment. Patients were either admitted for further care as required, followed up by outpatient services or discharged to their GP with details of the assessment and recommended follow-up.

Dr Aoife Leahy, consultant geriatrician, University Hospital Limerick and HSE Mid West, and the lead investigator for the SOLAR trial, commented, “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.”

Dr Leahy 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”.