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Conneely M, Holmes A, O'Connor M, Leahy A, Gabr A, Saleh A, Okpaje B, Corey G, Barry L, Griffin A, O'Shaughnessy Í, Ryan L, Synott A, McCarthy A, Carroll I, Leahy S, Trepél D, Ryan D, Robinson K, Galvin R. 265 A PHYSIOTHERAPY-LED TRANSITION TO HOME INTERVENTION FOR OLDER ADULTS FOLLOWING EMERGENCY DEPARTMENT DISCHARGE: A PILOT FEASIBILITY RANDOMISED-CONTROLLED TRIAL. Age Ageing 2022. [PMCID: PMC9620307 DOI: 10.1093/ageing/afac218.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Older adults frequently attend the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. A presentation to an ED can be viewed as an opportunity to assess those at risk of adverse outcomes and initiate a care plan in those deemed as ‘high risk'. Our aim was to evaluate the feasibility of a physiotherapy led integrated care intervention for older adults discharged from the ED (ED-PLUS). Methods Older adults presenting to the ED with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED-PLUS (Trial registration: NCT04983602). ED-PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s own home. Feasibility (recruitment and retention rates) and acceptability of the programme were assessed quantitatively and qualitatively. Functional decline was examined post-intervention using the Barthel Index. All outcomes were assessed by a research nurse blinded to group allocation. Results 29 participants were recruited, indicating 97% of our recruitment target. 90% of participants completed the ED-PLUS intervention. All participants expressed positive feedback about the intervention. The incidence of functional decline at 6 weeks was 10% in the ED-PLUS group versus 70-89% in the usual care and CGA-only groups. Conclusion High adherence and retention rates were observed among participants and preliminary findings indicate a lower incidence of functional decline in the ED-PLUS group. Recruitment challenges existed in the context of COVID-19. Data collection is ongoing for six-month outcomes.
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Affiliation(s)
- M Conneely
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - A Holmes
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - M O'Connor
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Leahy
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Gabr
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Saleh
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - B Okpaje
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - G Corey
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - L Barry
- University of Limerick School of Nursing and Midwifery, Faculty of Education and Health Sciences, , Limerick, Ireland
| | - A Griffin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - Í O'Shaughnessy
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - L Ryan
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A Synott
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - A McCarthy
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - I Carroll
- University Hospital Limerick Department of Ageing and Therapeutics, , Dooradoyle, Limerick, Ireland
| | - S Leahy
- School of Science & Computing, Atlantic Technological University, ATU Galway City Department of Sport, Exercise & Nutrition, , Old Dublin Road, Galway, Ireland
| | - D Trepél
- Trinity College Dublin Trinity Institute of Neurosciences, School of Medicine, , Ireland
| | - D Ryan
- University Hospital Limerick Limerick EM Education Research Training, Emergency Department, , Dooradoyle, Limerick, Ireland
| | - K Robinson
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - R Galvin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
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