Comprehensive Geriatric Assessment in the Emergency Department

  • Els DevriendtEmail author
  • Simon Conroy


Many older people who are admitted to hospital come via the emergency department which is a key interface in the health and social care system where older people with crises can be assessed. So it is important that emergency departments are appropriately supported in the management of older people.


  1. 1.
    Carter EJ, Pouch SM, Larson EL (2013) The relationship between emergency department crowding and patient outcomes: a systematic review. J Nurs Scholarsh 46(2):106–115CrossRefGoogle Scholar
  2. 2.
    Ernst & Young (2012) National Evaluation of the Department of Health’s integrated care pilots. RAND Europe, Cambridge, UK Google Scholar
  3. 3.
    Rubenstein LZ, Rubenstein LV (1991) Multidimensional assessment of elderly patients. Adv Intern Med 36:81–108PubMedGoogle Scholar
  4. 4.
    Shepperd S, Doll H, Broad J, Gladman J, Iliffe S, Langhorne P, et al (2009) Early discharge hospital at home. Cochrane Database Syst Rev Issue 1Google Scholar
  5. 5.
    Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills T, Rothman RE et al (2015) Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. Acad Emerg Med 22(1):1–21CrossRefGoogle Scholar
  6. 6.
    Salvi F, Belluigi A, Cherubini A (2013) Predictive validity of different modified versions of the identification of seniors at risk. J Am Geriatr Soc 61(3):462–464CrossRefGoogle Scholar
  7. 7.
    Di Bari M, Salvi F, Roberts AT, Balzi D, Lorenzetti B, Morichi V et al (2012) Prognostic stratification of elderly patients in the emergency department: a comparison between the “identification of seniors at risk” and the “silver code”. J Gerontol A Biol Sci Med Sci 67(5):544–550CrossRefGoogle Scholar
  8. 8.
    Ellis G, Langhorne P (2004) Comprehensive geriatric assessment for older hospital patients. Br Med Bull 71:45–59CrossRefGoogle Scholar
  9. 9.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefGoogle Scholar
  10. 10.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. JAMA 185:914–919CrossRefGoogle Scholar
  11. 11.
    Wellens NI, Deschodt M, Flamaing J, Moons P, Boonen S, Boman X et al (2011) First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting: a comparison of the minimum geriatric screening tools (MGST) and the interRAI acute care (interRAI AC). J Nutr Health Aging 15(8):638–644CrossRefGoogle Scholar
  12. 12.
    Rubenstein LZ, Stuck AE, Siu AL, Wieland D (1991) Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. J Am Geriatr Soc 39(9 Pt 2):8S–16S. discussion 17S-18SCrossRefGoogle Scholar
  13. 13.
    Bernabei R, Landi F, Onder G, Liperoti R, Gambassi G (2008) Second and third generation assessment instruments: the birth of standardization in geriatric care. J Gerontol A Biol Sci Med Sci 63(3):308–313CrossRefGoogle Scholar
  14. 14.
    Carpenter GI, Teare GF, Steel K, Berg K, Murphy K, Bjornson J et al (2001) A new assessment for elders admitted to acute care: reliability of the MDS-AC. Aging 13(4):316–330PubMedGoogle Scholar
  15. 15.
    Gray LC, Berg K, Fries BE, Henrard JC, Hirdes JP, Steel K et al (2009) Sharing clinical information across care settings: the birth of an integrated assessment system. BMC Health Serv Res 9:71CrossRefGoogle Scholar
  16. 16.
    Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J et al (2008) Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis.[see comment]. Lancet 371(9614):725–735CrossRefGoogle Scholar
  17. 17.
    Ellis G, Whitehead M, O’Neill D, Robinson D, Langhorne P (2011) Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Library: Cochrane collaborationGoogle Scholar
  18. 18.
    Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 343:d6553CrossRefGoogle Scholar
  19. 19.
    Deschodt M, Flamaing J, Haentjens P, Boonen S, Milisen K (2013) Impact of geriatric consultation teams on clinical outcome in acute hospitals: a systematic review and meta-analysis. BMC Med 11(1):48CrossRefGoogle Scholar
  20. 20.
    Van Craen K, Braes T, Wellens N, Denhaerynck K, Flamaing J, Moons P et al (2010) The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc 58(1):83–92CrossRefGoogle Scholar
  21. 21.
    Fox MT, Sidani S, Persaud M, Tregunno D, Maimets I, Brooks D et al (2013) Acute care for elders components of acute geriatric unit care: systematic descriptive review. J Am Geriatr Soc 61(6):939–946CrossRefGoogle Scholar
  22. 22.
    Fox MT, Persaud M, Maimets I, O’Brien K, Brooks D, Tregunno D et al (2012) Effectiveness of acute geriatric unit care using acute care for elders components: a systematic review and meta-analysis. J Am Geriatr Soc 60(12):2237–2245CrossRefGoogle Scholar
  23. 23.
    Wright PN, Tan G, Iliffe S, Lee D (2014) The impact of a new emergency admission avoidance system for older people on length of stay and same-day discharges. Age Ageing 43(1):116–121CrossRefGoogle Scholar
  24. 24.
    Davison J, Bond J, Dawson P, Steen IN, Kenny RA (2005) Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention--a randomised controlled trial.[see comment]. Age Ageing 34(2):162–168CrossRefGoogle Scholar
  25. 25.
    Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C (1999) Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 353:93–97CrossRefGoogle Scholar
  26. 26.
    McCusker J, Dendukuri N, Tousignant P, Verdon J, Poulin de Courval L, Belzile E (2003) Rapid two-stage emergency department intervention for seniors: impact on continuity of care. Acad Emerg Med 10(3):233–243CrossRefGoogle Scholar
  27. 27.
    Mion LC, Palmer RM, Meldon SW, Bass DM, Singer ME, Payne SM et al (2003) Case finding and referral model for emergency department elders: a randomized clinical trial. Ann Emerg Med 41(1):57–68CrossRefGoogle Scholar
  28. 28.
    Caplan GA, Williams AJ, Daly B, Abraham K (2004) A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. J Am Geriatr Soc 52(9):1417–1423CrossRefGoogle Scholar
  29. 29.
    Miller DK, Lewis LM, Nork MJ, Morley JE (1996) Controlled trial of a geriatric case-finding and liaison service in an emergency department. J Am Geriatr Soc 44(5):513–520CrossRefGoogle Scholar
  30. 30.
    Conroy SP, Stevens T, Parker SG, Gladman JRF (2011) A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’. Age Ageing 40(4):436–443CrossRefGoogle Scholar
  31. 31.
    Ellis G, Jamieson CA, Alcorn M, Devlin V (2012) An acute Care for Elders (ACE) unit in the emergency department. Eur Geriatr Med 3(4):261–263CrossRefGoogle Scholar
  32. 32.
    Keyes DC, Singal B, Kropf CW, Fisk A (2014) Impact of a new senior emergency department on emergency department recidivism, rate of hospital admission, and hospital length of stay. Ann Emerg Med 63(5):517–524CrossRefGoogle Scholar
  33. 33.
    Conroy SP, Ansari K, Williams M, Laithwaite E, Teasdale B, Dawson J et al (2014) A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ‘Emergency frailty Unit’. Age Ageing 43(1):109–114CrossRefGoogle Scholar
  34. 34.
    McCusker J, Verdon J, Tousignant P, de Courval LP, Dendukuri N, Belzile E (2001) Rapid emergency department intervention for older people reduces risk of functional decline: results of a multicenter randomized trial. J Am Geriatr Soc 49(10):1272–1281CrossRefGoogle Scholar
  35. 35.
    Basic D, Conforti DA (2005) A prospective, randomised controlled trial of an aged care nurse intervention within the emergency department. Aust Health Rev 29(1):51–59CrossRefGoogle Scholar
  36. 36.
    Foo CL, Siu VW, Tan TL, Ding YY, Seow E (2012) Geriatric assessment and intervention in an emergency department observation unit reduced re-attendance and hospitalisation rates. Australas J Ageing 31(1):40–46CrossRefGoogle Scholar
  37. 37.
    Arendts G, Fitzhardinge S, Pronk K, Donaldson M, Hutton M, Nagree Y (2012) The impact of early emergency department allied health intervention on admission rates in older people: a non-randomized clinical study. BMC Geriatr 12:8CrossRefGoogle Scholar
  38. 38.
    Arendts G, Fitzhardinge S, Pronk K, Hutton M (2013) Outcomes in older patients requiring comprehensive allied health care prior to discharge from the emergency department. Emerg Med Australas 25(2):127–131CrossRefGoogle Scholar
  39. 39.
    Foo CL, Siu VW, Ang H, Phuah MW, Ooi CK (2014) Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial. BMC Geriatr 14:98CrossRefGoogle Scholar
  40. 40.
    Eeles EMP, White SV, O’Mahony SM, Bayer AJ, Hubbard RE (2012) The impact of frailty and delirium on mortality in older inpatients. Age Ageing 41(3):412–416CrossRefGoogle Scholar
  41. 41.
    Dendukuri N, McCusker J, Belzile E (2004) The identification of seniors at risk screening tool: further evidence of concurrent and predictive validity. J Am Geriatr Soc 52(2):290–296CrossRefGoogle Scholar
  42. 42.
    Deschodt M, Wellens NIH, Braes T, De Vuyst A, Boonen S, Flamaing J et al (2011) Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools. Aging Clin Exp Res 23(5-6):421–426CrossRefGoogle Scholar
  43. 43.
    Braes T, Moons P, Lipkens P, Sterckx W, Sabbe M, Flamaing J et al (2010) Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments. Aging Clin Exp Res 22(4):345–351CrossRefGoogle Scholar
  44. 44.
    Lee JS, Schwindt G, Langevin M, Moghabghab R, Alibhai SMH, Kiss A et al (2008) Validation of the triage risk stratification tool to identify older persons at risk for hospital admission and returning to the emergency department. J Am Geriatr Soc 56(11):2112–2117CrossRefGoogle Scholar
  45. 45.
    Graf CE, Giannelli SV, Herrmann FR, Sarasin FP, Michel J-P, Zekry D et al (2012) Can we improve the detection of old patients at higher risk for readmission after an emergency department visit? J Am Geriatr Soc 60(7):1372–1373CrossRefGoogle Scholar
  46. 46.
    Schumacher JG (2005) Emergency medicine and older adults: continuing challenges and opportunities. Am J Emerg Med 23(4):556–560CrossRefGoogle Scholar
  47. 47.
    Wade DT, Collin C (1988) The Barthel ADL index: a standard measure of physical disability? Int Disabil Stud 10:64–67CrossRefGoogle Scholar
  48. 48.
    Borson S, Scanlan JM, Chen P, Ganguli M (2003) The mini-cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc 51(10):1451–1454CrossRefGoogle Scholar
  49. 49.
    Bellelli G, Morandi A, Davis DH, Mazzola P, Turco R, Gentile S et al (2014) Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing 43(4):496–502CrossRefGoogle Scholar
  50. 50.
    Bradshaw LE, Goldberg SE, Lewis SA, Whittamore K, Gladman JRF, Jones RG et al (2013) Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs. Age Ageing 42(5):582–588CrossRefGoogle Scholar
  51. 51.
    Rinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G et al (2003) Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc 51(5):694–698CrossRefGoogle Scholar
  52. 52.
    Dennis MS, Wakefield P, Molloy C, Andrews H, Friedman T, Dennis MS et al (2007) A study of self-harm in older people: mental disorder, social factors and motives. Aging Ment Health 11(5):520–525CrossRefGoogle Scholar
  53. 53.
    Hawton K, Harriss L, Hawton K, Harriss L (2006) Deliberate self-harm in people aged 60 years and over: characteristics and outcome of a 20-year cohort. Int J Geriatr Psychiatry 21(6):572–581CrossRefGoogle Scholar
  54. 54.
    Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ et al (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329(7456):15–19CrossRefGoogle Scholar
  55. 55.
    Beijer H, de Blaey C (2002) Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 24:46–54CrossRefGoogle Scholar
  56. 56.
    Mannesse CK, Derkx FH, de Ridder MA, Man In't Veld AJ, van der Cammen TJ (2000) Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 29(1):35–39CrossRefGoogle Scholar
  57. 57.
    Ellis G, Marshall T, Ritchie C (2014) Comprehensive geriatric assessment in the emergency department. Clin Interv Aging 9:2033–2043CrossRefGoogle Scholar
  58. 58.
    Shepperd S, Doll H, Angus R, Clarke M, Iliffe S, Kalra L, et al (2008) Admission avoidance hospital at home. Cochrane Database Syst Rev Issue 4Google Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.Department of Public Health and Primary CareAcademic Centre for Nursing and Midwifery, KU LeuvenLeuvenBelgium
  2. 2.Department of Geriatric MedicineUniversity Hospitals LeuvenLeuvenBelgium
  3. 3.Department of Health SciencesUniversity of LeicesterLeicesterUnited Kingdom

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