SOLAR- Frailty Screening and Multidisciplinary Assessment of Older Adults in the Emergency Department

Study Overview
=================
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.

Official Title
-----------------
The Impact of Frailty Screening of Older Adults With muLtidisciplinary Assessment of Those At Risk During Emergency Hospital Attendance on the Quality, Safety and Cost-effectiveness of Care (SOLAR): a Randomised Controlled Trial

Conditions
-----------------
Frailty

Intervention / Treatment
-----------------
* Other: SOLAR


Participation Criteria
=================
Eligibility Criteria
-----------------
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.

Ages Eligible for Study
-----------------
Minimum Age: 75 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomised control trial
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control Arm<br>The control group will obtain usual medical care in the Emergency Department and Acute Medical Assessment Unit | |
| Experimental: SOLAR arm<br>The SOLAR arm will obtain a comprehensive geriatric assessment which will be provided by a geriatric doctor, physiotherapist, occupational therapist, social worker, pharmacist and specialist nurse. | Other: SOLAR<br>* 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.<br>* Other names: Comprehensive Geriatric Assessment;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Experience Times (PET) | PET time recorded as time of arrival at the ED to discharge or admission | Exact time of admission or discharge from ED will be collected at 30 days from index visit | 
| Time to admission or discharge and if for admission, time that the bed is booked to go to medical wards. | This is the time that the patient is either discharged or identified for admission and bed booked to go to the medical wards | Exact time of admission or discharge from ED will be collected at 30 days from index visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of ED Representation | A record of the patient coming back to the ED within 30 days and/or 6 months | 30 days and 6 months | 
| Mortality | A record of the patient having died within 30 days or 6 months | 30 days and 6 months | 
| Rate of Hospital Readmission | A record of the patient requiring admission to the hospital within 30 days or 6 months | 30 days and 6 months | 
| Functional Decline | 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. | 30 days and 6 months | 
| Patient Satisfaction- | 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. | 30 days | 
| Patient Quality of Life | 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 | 30 days | 
| Number of visits to family doctor, therapists or public health nurse | 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. | 30 days and 6 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Frailty, Comprehensive Geriatric Assessment, Emergency Department, Older Adults