Early allied health assessment for frail older adults.

The first 120 participants will be consecutively recruited to the control group where they will receive standard allied health care. The following 120 patients will receive the intervention, an early allied health assessment. Case matching between groups will be used based on age, gender, diagnosis and Clinical Frailty Scale (CFS). The intervention group will receive early allied health input (completed by either a senior occupational therapist or physiotherapist) within one hour of presenting to the emergency department (ED). An early assessment will include obtaining verbal handover from the ambulance officers (if able), initial interview with the patient and/or caregiver, review of their current function and cognitive review. The early allied health assessment will take approximately 20-30 minutes to complete and include self-reported social history, pre-presentation physical function using a modified version of the Functional Independence Measure/Functional Assessment Method (FIM/FAM), falls history in the last 12 months and home environment setup, as well as a cognitive review (using the 4 ‘A’s Test [4AT]) and a Clinical Frailty Scale (CFS) score. A review of patients current function will be dependent on their reason for presentation, any contraindications for mobilising (i.e., concern there is a fracture, unable to mobilise since presentation) and their state of discomfort (i.e., complaints of pain or shortness of breath). Any concerns regarding assessing a patients function will be discussed with the nursing staff and triage/Rapid Assessment Team (RAT) doctor. Initial interview and current function will be documented in the patient’s medical record. Individualised interventions such as falls risk minimisation strategies, nutrition and hydration assistance, prevention of medication adverse events (e.g. missed doses, lack of analgesia), promoting mobilisation and toileting, optimisation of patient positioning and pressure injury prevention, communication assistance (hearing device provision, speech to text device and app, information leaflets) and education may be recommended to support understanding and expectations of ED processes, maintenance of function and minimise adverse events during their ED stay. Patients that do not require further input from the ED allied health team will be discharged from the service with any equipment or outpatient referrals (such as home visiting, Rehabilitation in the Home [RITH] or outpatient geriatric clinics) completed by the early intervention therapist. Those patients requiring further allied health input, such as further assessment of function or cognition, will be referred to the ED allied health team within the department for ongoing assessment and management. Referrals may also be made to the ED social work team. Verbal feedback will be provided to the allocated doctor for consideration during their assessment, including patients frailty score and risks, frailty interventions addressed (i.e., falls, cognition/delirium risk, continence), allied health recommendations (i.e., current function, social situations, discharge recommendations), advocating for specialist team input (i.e., geriatric team), transfer to specific ED areas for treatment and admission. At the end of a patients presentation medical records will be reviewed regarding frailty interventions provided and referrals made to address frailty syndromes.