Clinical trial NCT04629690: SOLAR- Frailty Screening and Multidisciplinary Assessment of Older Adults in the Emergency Department
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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Frailty
Keywords: Comprehensive Geriatric Assessment
Emergency Department
Older Adults
Frailty
Lead sponsor: University of Limerick
Sponsor class: OTHER
Collaborators: name: University Hospital of Limerick
First posted: 2020-11-16
Enrollment: 229
Sex: ALL
Minimum age (years): 75
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Randomised control trial
Primary purpose: TREATMENT

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.

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.

Primary outcomes:
measure: Patient Experience Times (PET)
timeFrame: Exact time of admission or discharge from ED will be collected at 30 days from index visit
measure: Time to admission or discharge and if for admission, time that the bed is booked to go to medical wards.
timeFrame: Exact time of admission or discharge from ED will be collected at 30 days from index visit
Secondary outcomes:
measure: Rate of ED Representation
timeFrame: 30 days and 6 months
measure: Mortality
timeFrame: 30 days and 6 months
measure: Rate of Hospital Readmission
timeFrame: 30 days and 6 months
measure: Functional Decline
timeFrame: 30 days and 6 months
measure: Patient Satisfaction-
timeFrame: 30 days
measure: Patient Quality of Life
timeFrame: 30 days
measure: Number of visits to family doctor, therapists or public health nurse
timeFrame: 30 days and 6 months
Other outcomes:
Locations:
city: Limerick
country: Ireland
facility: University Hospital Limerick
Study officials:
affiliation: University of Limerick
name: Rose Galvin, phD
role: PRINCIPAL_INVESTIGATOR
References:
citation: McCusker J, Bellavance F, Cardin S, Trepanier S, Verdon J, Ardman O. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc. 1999 Oct;47(10):1229-37. doi: 10.1111/j.1532-5415.1999.tb05204.x.
citation: Leahy A, McNamara R, Reddin C, Corey G, Carroll I; SOLAR team; O'Neill A, Flannery D, Devlin C, Barry L, MacCarthy B, Cummins N, Shanahan E, Shchetkovsky D, Ryan D, O'Connor M, Galvin R. 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. Trials. 2021 Aug 31;22(1):581. doi: 10.1186/s13063-021-05525-w.