Clinical and process outcomes for older adults in the Geriatric Emergency Medicine Unit (GEM-U)
A Prospective Cohort Study of the Clinical and Process Outcomes of Older Adults That Transition Through the Geriatric Emergency Medicine Unit (GEM-U)
See if specialist geriatric emergency unit care leads to better function, quality of life, and lower hospital use for people aged 75 and older with frailty.
Quick facts
| Study type | Observational |
|---|---|
| Enrollment | 150 (estimated) |
| Ages | 75 Years and up |
| Sex | All |
| Sponsor | University of Limerick Academic / other |
| Locations | 1 site (Limerick, Munster) |
| Trial ID | NCT07237334 on ClinicalTrials.gov |
What this trial studies
This is a prospective cohort study that follows patients aged 75 and older who pass through the Geriatric Emergency Medicine Unit and are reviewed by the Older Persons Integrated Care Team. Participants who screen positive on ISAR (≥2) and present with a medical problem are enrolled and characterized using comprehensive geriatric assessment tools including the Barthel Index, 4AT (± Delirium Rating Scale), Clinical Frailty Scale, Mini Nutritional Assessment, EQ-5D-5L, and PSQ-18. Clinical and process outcomes such as acute hospital admission, function, nutrition, delirium, frailty status, quality of life, and patient satisfaction are recorded at baseline, 30 days, and 6 months. All participants provide informed consent, reporting follows STROBE guidelines, and data will be analyzed statistically to describe outcomes and associations.
Who should consider this trial
Good fit: Ideal candidates are adults aged 75 or older who present to the ED with a medical problem, are Manchester Triage categories 2–5, screen positive on ISAR (≥2), and are reviewed by the Older Persons Integrated Care Team.
Not a fit: Patients with non-medical presentations such as major trauma or hip fracture, acute stroke/TIA, acute coronary syndrome or unstable arrhythmia, those requiring resuscitation or with low Glasgow Coma Scale, or those routed to other specialized pathways are excluded and unlikely to benefit from the GEM-U pathway in this study.
Why it matters
Potential benefit: If successful, this work could help reduce hospital admissions and improve function, quality of life, and patient satisfaction for frail older adults seen in the emergency department.
How similar studies have performed: Similar geriatric emergency unit programs and use of comprehensive geriatric assessment in ED settings have shown mixed but generally promising results, with some studies reporting reduced admissions and improved function and satisfaction though high-quality definitive evidence is still limited.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Older adults aged ≥75 years * Manchester Triage System category 2-5 * Screen positive for risk of adverse outcomes after ED visit (≥ 2 on ISAR screening tool) * Presenting with a medical condition * Reviewed by the Older Persons Integrated Care Team Exclusion Criteria: * Patients presenting with a non-medical issue including major trauma or hip fracture * Patients presenting with acute stroke or transient ischaemic attack * Patients more appropriate to another alternative pathway e.g. deep vein thrombosis pathway, low risk chest pain pathway * Patients with acute coronary syndrome or unstable arrthymia * Patients requiring care in the resuscitation room * Patients with head injury (unless appropriate assessment and management has been fully completed by ED team) * Patients with possible spinal injury (unless appropriate assessment and management has been fully completed by ED/orthopaedic team) * Patients with low Glasgow Coma Scale * Other exclusions at the discretion of the Older Persons Integrated Care team depending on team capacity and expertise * Exclusion criteria as set out above, are in line with those set out in the UHL Operating Policy of the Older Persons Integrated Care Team.
Where this trial is running
Limerick, Munster
- University Hospital Limerick — Limerick, Munster, Ireland (Recruiting)
Study contacts
- Principal investigator: Ida Carroll — University of Limerick
- Study coordinator: Ida M Carroll, MSc
- Email: 09006791@studentmail.ul.ie
- Phone: 0860638269
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.