LO77: Compliance of older emergency department patients to community-based specialized geriatric services

Introduction: The Geriatric Emergency Management (GEM) model has been developed to facilitate identification of older patients that are at higher risk of functional decline, repeat Emergency Department (ED) visits and future hospitalization. Those identified at risk, are referred for more in-depth evaluation and management in community-based specialized geriatric services. Our objective was to: 1) determine the compliance rate to outpatient evaluation following ED recommendation; and 2) identify barriers and facilitators to attendance. Methods: We conducted a prospective cohort study at two sites of an academic, tertiary level hospital ED between July and December 2016. We enrolled a convenience sample of ED patients, 65 years and older who were seen by a GEM nurse, referred to outpatient specialized geriatric services and consented to study participation. The GEM nurses conducted targeted geriatric assessments, identifying those who would benefit from further community management. We conducted a chart review and a structured telephone follow-up at 6 weeks. Descriptive statistics were used. Results: A total of 101 patients were prospectively enrolled, with 30.4% of eligible participants declining outpatient referral. Enrolled subjects had a mean age of 83.3 years, 58.4% female and 62.0% cognitively impaired. Reasons for referral to specialized geriatric services included: mobility (86.1%), cognition (57.4%), pain (38.6%), mood (34.7%), medication management (33.6%) and nutrition (30.7%). Outpatient referrals were to: geriatric day hospital (51.5%), geriatric outreach (22.7%), falls clinic (11.8%) and geriatric psychiatry (9.9%). Compliance with follow-up within 6 weeks was 64.4%. Barriers to attendance included: patient did not feel specialized geriatric services was needed (52.6%); admitted to hospital (10.5%); reported not called for appointment (15.8%); forgot appointment (5.3%) and transportation (5.3%). Family support with scheduling and transportation to appointments, reported by 68.6%, was the most common enabler to compliance. Conclusion: Over one third of older ED patients referred by GEM for further specialized geriatric services are non-compliant with their community-based evaluation, while one in four older ED patients decline referral to these evaluations while in the ED. Future work should focus on interventions that promote increased referral acceptance and address barriers to attendance.