Demographics, clinical features and outcomes of older patients presenting to an Irish emergency department.

BACKGROUND

Older adults represent an increasingly significant proportion of Emergency Department (ED) attendances in Ireland, often presenting with complex geriatric syndromes including frailty, cognitive impairment, and multi-morbidity. Tallaght University Hospital (TUH) introduced the Gerontological Emergency Department Intervention (GEDI) team in 2018 to address the needs of this vulnerable cohort through comprehensive geriatric assessment (CGA).

AIM: To characterise the demographics, clinical features, and outcomes of older patients assessed by the GEDI team in TUH ED over a five-year period, and to identify factors independently associated with hospital admission.

METHODS

A retrospective observational study was conducted using routinely collected data on all patients assessed by the GEDI team from January 1, 2020 to December 31, 2024. Patient demographics, presenting complaints, CGA components (Rockwood Frailty Score, Barthel Index, 4AT, Mini Nutritional Assessment, SARC-F), ED length of stay, and disposition outcomes were analysed. Multivariate logistic regression identified independent predictors of hospital admission.

RESULTS

Over the study period, 11,256 ED presentations pertaining to 7,055 older patients were assessed by the GEDI team. The mean age was 81.1 years (SD 6.6); 55% were female. The most common presenting complaints were musculoskeletal issues (19.2%) and falls (13.1%). Most patients (64.2%) were moderately frail; 20.6% screened positive for possible delirium. Over one-third were at risk of malnutrition and 48.4% were at risk of sarcopenia. The hospital admission rate was 61.5%. Increasing age, frailty, delirium risk, malnutrition risk, sarcopenia risk, and longer ED stay were independently associated with hospital admission (p < 0.05).

CONCLUSION

This study highlights the clinical complexity of older adults presenting to ED and the utility of interdisciplinary CGA in identifying high-risk features predictive of hospitalisation. These findings support the continued development of integrated geriatric emergency care pathways and reinforce the need for targeted resourcing of geriatric services in Irish EDs.