Physiotherapy Led Community Intervention for Older Adults Discharged From the Emergency Department

The Effectiveness of a Physiotherapy Led Community Based Intervention at Reducing Adverse Outcomes in Older Adults Discharged From the Emergency Department: A Pilot Feasibility Randomized Controlled Trial

ED PLUS Emergency Department Discharge Physiotherapy Led Community Service is a pilot feasibility randomized controlled trial investigating the role of an integrated care intervention consisting of comprehensive geriatrics assessment in older adults in the emergency department and a physiotherapy-led community based intervention.

All patients who are aged 65 years and over will be screened using the Identification of Seniors at Risk (ISAR) Tool in the emergency department of a University Teaching Hospital. Those with a score of 2 or above in the ISAR and suitable for discharge home will be randomised. The first treatment arm will undergo geriatric medicine item directed Comprehensive Geriatric Assessment (CGA) from admission to emergency department (ED). The non-treatment arm will under usual patient care. The second treatment arm will undergo geriatric medicine team directed CGA from admission to ED and a physiotherapy led community based 6 week intervention in the patient's home. A dedicated multidisciplinary team of geriatric medicine trainee, occupational therapist, physiotherapist and medical social worker will carry out the assessment. For those randomised to the second treatment arm, a physiotherapist will assess and carry out a 6 week interventions that arise from that assessment and liaise with the patients General Practitioner (GP), medical social worker and other health care professionals. The overall aims of ED PLUS are assess the feasibility of the 6 week physiotherapy led intervention. Feasibility will be determined by the following outcomes:

i) Recruitment rate

ii) Adherence rate

iii) Acceptability of the programme

iv) Retention

v) Incidents

The secondary aims are to improve function, reduce anxiety and depression, improve quality of life and prevent unnecessary ED admission.

The inclusion criteria for participants include:

• Adults aged ≥65 years with undifferentiated medical complaints presenting to an ED.
• Medically stable as deemed by the treating physician
• Display a score of ≥2 on the Identification of Seniors at Risk (ISAR) screening tool.
• Be community dwelling
• Be discharged from the ED within 72 hours of index visit.

Exclusion criteria include:

• Individuals under the age of 65 years.
• Have a score of less than 2 on the ISAR.
• Older adults who present with acute myocardial infarction, stroke or non-medical problems e.g. surgical or psychiatric issues.
• Older adults who are medically unstable will be excluded.
• If neither the patient nor carer can communicate in English sufficiently to complete consent or baseline assessment, they will be excluded.
• Older adults who are admitted to hospital from the ED will be excluded.
• Older adults who have a confirmed COVID 19 diagnosis or those with symptoms highly suggestive of COVID 19 will be excluded.