Frailty
Conditions
Keywords
Comprehensive Geriatric Assessment, Emergency Department, Older Adults, Frailty
Brief summary
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.
Detailed description
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.
Interventions
OTHERSOLAR
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.
Sponsors
University Hospital of Limerick
University of Limerick
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The outcome assessor will be unaware if the participant was in control or intervention arm
Intervention model description
Randomised control trial
Eligibility
Sex/Gender
ALL
Age
75 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Older adults aged 75 years or over * Medically stable as deemed by the treating physician * A score of 2 or above on the ISAR * Present with a medical complaint
Exclusion criteria
* Those under the age of 75 years * A score of less than 2 on the ISAR * Acute myocardial infarction, stroke or non-medical problems e.g. surgical or psychiatric issues * Patients who are medically unstable * If neither the patient nor carer can communicate in English sufficiently to complete consent or baseline assessment * Confirmed or highly suspicious of symptoms for COVID 19.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient Experience Times (PET) | Exact time of admission or discharge from ED will be collected at 30 days from index visit | PET time recorded as time of arrival at the ED to discharge or admission |
| Time to admission or discharge and if for admission, time that the bed is booked to go to medical wards. | Exact time of admission or discharge from ED will be collected at 30 days from index visit | This is the time that the patient is either discharged or identified for admission and bed booked to go to the medical wards |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Hospital Readmission | 30 days and 6 months | A record of the patient requiring admission to the hospital within 30 days or 6 months |
| Functional Decline | 30 days and 6 months | 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. |
| Rate of ED Representation | 30 days and 6 months | A record of the patient coming back to the ED within 30 days and/or 6 months |
| Patient Quality of Life | 30 days | 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 |
| Number of visits to family doctor, therapists or public health nurse | 30 days and 6 months | 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. |
| Patient Satisfaction- | 30 days | 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. |
| Mortality | 30 days and 6 months | A record of the patient having died within 30 days or 6 months |
Countries
Ireland
Outcome results
None listed