343 RIGHT CARE, RIGHT PLACE, RIGHT TIME? WHAT PROPORTION OF ACUTELY-UNWELL OLDER PATIENTS UNDERGO EVIDENCE-BASED COMPREHENSIVE GERIATRIC ASSESSMENT?

Abstract

Abstract Background There is robust evidence that Comprehensive Geriatric Assessment (CGA) improves outcomes for acutely unwell older people. Relatively little research has examined how this translates to real life clinical settings, however. The aim of this study therefore was to ascertain how many older people admitted to hospital underwent CGA and how this impacted on readmission rates. Methods The study site is a large teaching hospital with 150 specialist geriatric medicine beds and ‘specialty-take’ of frail, older people by the geriatric medicine service. Data pertaining to contact with a geriatric medicine service were collected for 400 consecutive ED presentations of patients aged ≥70 years from 1/1/21, as well as Clinical Frailty Scale (CFS) and readmission within 30 days. Results Over one-third (139/400, mean CFS 3.7) of patients were discharged home directly from the ED, with the remainder (261/400, mean CFS 4.5) admitted to hospital. Almost-half overall (122/261, mean CFS 4.7) and 58% of those ≥80 years, were admitted under the care of a geriatrician, with 73% (89/122) cared for on a specialist geriatric medicine ward. Of those not admitted under a geriatrician, 10% (13/139) subsequently underwent CGA on a consultation basis. In total, 48% (126/261, mean CFS 3.7) of patients ≥70 years, including one-third of those ≥80 years with a CFS≥5 (36/99), completed their admission without undergoing CGA. Of those ≥80 years with a CFS≥5 who did not receive CGA, readmission within 30 days was 24% compared to 13% for those who underwent CGA. Conclusion Patients who underwent CGA were older, with higher levels of frailty. However, one-third of those aged ≥80 years with CFS ≥5 did not undergo CGA and early readmission was higher in this cohort. CGA in the acute setting is a finite resource and it is imperative it is delivered to those who require it most.