E.CHONG1, B.ZHU1, S.H.X.NG2, H.TAN3, E.F.GOH1, J.D.C.MOLINA2, M.J.PEREIRA2, P.KAUR2, J.BALDEVARONA-LLEGO1, J.Q.CHIA1, A.CHONG1, S.CHEONG1, C.L.FOO1, M.CHAN1, W.S.LIM1
Tan Tock Seng Hospital1, National Healthcare Group HQ2, Woodlands Health3
Emergency Department Interventions for Frailty (EDIFY) delivers frailty-centric interventions at the Emergency Department (ED). We evaluated the effectiveness of a multicomponent frailty intervention (MFI) in improving functional outcomes among older persons.
This is a quasi-experimental study in a 30-bed ED observation unit at Tan Tock Seng Hospital including patients aged ≥65 years, categorised as Clinical Frailty Scale 4-6, and planned for discharge from the unit. We compared patients receiving the MFI versus usual-care. Data on demographics, function, frailty, sarcopenia, comorbidities, and medications were gathered. Our primary outcome was functional status – Modified Barthel Index (MBI) and Lawton’s iADL. Secondary outcomes include hospitalisation, ED re-attendance, mortality, frailty, sarcopenia, polypharmacy, and falls. Follow-up assessments were at 3, 6, and 12 months.
We recruited 140 participants (mean age: 79.7±7.6 years). Baseline characteristics between groups were comparable (each n=70). For the intervention group, MBI scores were significantly higher at 6-month (mean: 94.5±11.2 vs. 88.5±19.5,p=0.04) while Lawton’s iADL scores experienced less decline (change-in-score: 0.0±1.7 vs. -1.1±1.8,p=0.001). Model-based analyses revealed greater odds of maintaining/improving MBI in the intervention group at 6-month [Odds Ratio (OR) 2.51, 95% Confidence Interval (CI) 1.04-6.03,p=0.04] and 12-month (OR 2.98, 95%CI 1.18-7.54,p=0.02). This was similar for Lawton’s iADL at 12-month (OR 4.01, 95%CI 1.70-9.48,p=0.002). ED re-attendances (Rate Ratio 0.35, 95%CI 0.13-0.90,p=0.03) and progression to sarcopenia (OR 0.19, 95%CI 0.04-0.94,p=0.04) were also lower at 6-month.
The MFI delivered to older persons at the ED can improve functional outcomes and possibly reduce ED re-attendances while attenuating sarcopenia progression.