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| Name | Class |
|---|---|
| University Hospital of Limerick | OTHER |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Arm | No Intervention | The control group will obtain usual medical care in the Emergency Department and Acute Medical Assessment Unit | |
| SOLAR arm | Experimental | The SOLAR arm will obtain a comprehensive geriatric assessment which will be provided by a geriatric doctor, physiotherapist, occupational therapist, social worker, pharmacist and specialist nurse. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| SOLAR | Other | The participants will obtain a multidisciplinary assessment regarding their medical conditions, medication review, cognitive assessment, functional assessment, gait and balance assessment by senior clinicians and a management plan will be implemented. |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Experience Times (PET) | PET time recorded as time of arrival at the ED to discharge or admission | Exact time of admission or discharge from ED will be collected at 30 days from index visit |
| Time to admission or discharge and if for admission, time that the bed is booked to go to medical wards. | This is the time that the patient is either discharged or identified for admission and bed booked to go to the medical wards | Exact time of admission or discharge from ED will be collected at 30 days from index visit |
| Measure | Description | Time Frame |
|---|---|---|
| Rate of ED Representation | A record of the patient coming back to the ED within 30 days and/or 6 months | 30 days and 6 months |
| Mortality | A record of the patient having died within 30 days or 6 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Rose Galvin, phD | University of Limerick | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital Limerick | Limerick | v | Ireland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 10522957 | Background | 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. | |
| 39541993 | Derived | Leahy A, Barry L, Corey G, Whiston A, Purtill H; SOLAR team; Shanahan E, Shchetkovsky D, Ryan D, O'Loughlin M, O'Connor M, Galvin R. Frailty screening with comprehensive geriatrician-led multidisciplinary assessment for older adults during emergency hospital attendance in Ireland (SOLAR): a randomised controlled trial. Lancet Healthy Longev. 2024 Nov;5(11):100642. doi: 10.1016/j.lanhl.2024.100642. Epub 2024 Nov 11. |
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Individual data will be stored on a data repository after the study analysis.
The study protocol will be prepared for publication in an open access journal. the study protocol will include the Statistical Analysis Plan and Informed Consent Form. It is likely to be published in Quarter 2 of 2021.
The Clinical Study Report will be made publicly available in the form of a peer reviewed publication in late 2021.
Supporting information will be available on peer reviewed publications.
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| ID | Term |
|---|---|
| D000073496 | Frailty |
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D020969 | Disease Attributes |
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| ID | Term |
|---|---|
| D015577 | Geriatric Assessment |
| ID | Term |
|---|---|
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D006304 | Health Status |
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Randomised control trial
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The outcome assessor will be unaware if the participant was in control or intervention arm
|
| 30 days and 6 months |
| Rate of Hospital Readmission | A record of the patient requiring admission to the hospital within 30 days or 6 months | 30 days and 6 months |
| Functional Decline | As determined by the Barthel Index. Barthel Index is a score from 0-20. A score of 0 is completely dependent, 20 is fully independent. | 30 days and 6 months |
| Patient Satisfaction- | As determined by the Patient Satisfaction Survey III Short Form (PSQ18). This is scored from 18 to 90. 18 being the worst score and 90 being the best score. | 30 days |
| Patient Quality of Life | As determined by the Euro Quality of Life (Qol) EQ5D. Scored from 0 to 100. 0 is worst imaginable health state with 100 being the best imaginable health state | 30 days |
| Number of visits to family doctor, therapists or public health nurse | Determined by self reported visits to family doctor, allied health services or Public Health Nurse. There will be a telephone consultation at 30 days and 6 months where patients will be asked if they have visited a family doctor, therapist or public health nurse in the previous 30 days at the 30 day telephone call, or 6 months at the 6 month phone call. | 30 days and 6 months |
| 34465368 | Derived | 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. |
| D003710 |
| Demography |
| D011154 | Population Characteristics |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D015991 | Epidemiologic Measurements |
| D011634 | Public Health |
| D004778 | Environment and Public Health |