SOLAR is a randomised control trial exploring the role of Comprehensive Geriatric Assessment (CGA) in older adults who screen positive for frailty based on the Identification of Seniors at Risk (ISAR) tool the the Emergency Department and Acute Medical Assessment Unit of a University Teaching Hospital.
All patients who are over seventy-five will be screened for frailty using the widely used ISAR tool. Those with a score of 2 or above in the ISAR will be randomised. The treatment arm will undergo geriatric medicine team-directed CGA from admission to Emergency Department (ED) or Acute Medical Assessment Unit (AMAU) whereby the non-treatment arm will undergo usual patient care. A dedicated multidisciplinary team of a geriatric medicine trainee, physiotherapist, occupational therapist and medical social worker will carry out the assessment, as well as interventions that arise from that assessment. Primary outcomes will be time from triage to decision to admit or discharge. Secondary Outcomes will be subsequent Emergency Department reattendance, rehospitalisation, functional decline and mortality at 30 days and 180 days. This will be recorded by telephone consultation and electronic records.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
229
The participants will obtain a multidisciplinary assessment regarding their medical conditions, medication review, cognitive assessment, functional assessment, gait and balance assessment by senior clinicians and a management plan will be implemented.
University Hospital Limerick
Limerick, Ireland
Patient Experience Times (PET)
PET time recorded as time of arrival at the ED to discharge or admission
Time frame: Exact time of admission or discharge from ED will be collected at 30 days from index visit
Time to admission or discharge and if for admission, time that the bed is booked to go to medical wards.
This is the time that the patient is either discharged or identified for admission and bed booked to go to the medical wards
Time frame: Exact time of admission or discharge from ED will be collected at 30 days from index visit
Rate of ED Representation
A record of the patient coming back to the ED within 30 days and/or 6 months
Time frame: 30 days and 6 months
Mortality
A record of the patient having died within 30 days or 6 months
Time frame: 30 days and 6 months
Rate of Hospital Readmission
A record of the patient requiring admission to the hospital within 30 days or 6 months
Time frame: 30 days and 6 months
Functional Decline
As determined by the Barthel Index. Barthel Index is a score from 0-20. A score of 0 is completely dependent, 20 is fully independent.
Time frame: 30 days and 6 months
Patient Satisfaction-
As determined by the Patient Satisfaction Survey III Short Form (PSQ18). This is scored from 18 to 90. 18 being the worst score and 90 being the best score.
Time frame: 30 days
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Patient Quality of Life
As determined by the Euro Quality of Life (Qol) EQ5D. Scored from 0 to 100. 0 is worst imaginable health state with 100 being the best imaginable health state
Time frame: 30 days
Number of visits to family doctor, therapists or public health nurse
Determined by self reported visits to family doctor, allied health services or Public Health Nurse. There will be a telephone consultation at 30 days and 6 months where patients will be asked if they have visited a family doctor, therapist or public health nurse in the previous 30 days at the 30 day telephone call, or 6 months at the 6 month phone call.
Time frame: 30 days and 6 months