Effectiveness of a Geriatric Emergency Medicine Unit for the Management of Neurocognitive Disorders in Older Patients: Results of the MUPACog Study

Abstract

<b><i>Introduction:</i></b> The prevalence of neurocognitive disorders (NCDs) increases with age and is associated with cognitive impairment. Older patients with NCD admitted to the emergency department (ED) are readmitted after discharge to home more often than those without NCD. Comprehensive geriatric assessment (CGA) is effective for improving clinical outcomes in older patients; however, the usefulness of CGA for older patients with NCD admitted to the ED has not been investigated. The main objective of our study is to assess the effectiveness of a geriatric emergency medicine unit (GEMU) for elderly patients with NCD admitted to the ED. <b><i>Methods:</i></b> This historical cohort study included patients aged 75 years and older with NCD admitted to the ED of Limoges University Hospital in France over a 4-year period. We compared patients treated in our hospital’s GEMU, the MUPA unit (exposed group), and patients who received standard care by emergency physicians (control group). The primary end point was the incidence of 30-day readmissions. <b><i>Results:</i></b> The study included 801 patients admitted to the ED between January 1, 2015, and December 31, 2018 (400 in the exposed group). Of those, 72.5% were female, and the mean age was 87 ± 5 years. After adjusting for confounding factors, the 30-day readmission rate was significantly associated with the MUPA unit intervention. <b><i>Conclusion:</i></b> CGA in a GEMU improved health outcomes in elderly patients with NCD in the ED. We recommend that all EDs include a geriatric team, such as the MUPA unit, to treat all patients with NCD admitted to the ED.

Emergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review

“… 34 – 40 The participation rate of individuals with cognitive impairment ranged from 3% to 100%, 34 – 40 with 2 studies targeting cognitively impaired ED patients. 35 , 40 The mean age of study participants ranged from 78 to 87 years, and the majority of participants were female. 34 – 40 No study reported the racial or ethnic backgrounds of study participants.…”

“…Five studies included comprehensive geriatric assessments or exposure to geriatric-specific ED services such as assessments of vulnerabilities, physical function, polypharmacy, multimorbidity, and/or social supports. 34 , 35 , 37 – 39 Other intervention elements within multiple studies included enhanced discharge planning (eg, follow-up visits) and referrals to primary care or specialist services. 34 – 38 , 40 The remaining study had trained community paramedics make home visits.…”

“…Of the 7 studies, 1 was a conference abstract (prospective cohort study), 39 2 were prospective cohort studies, 34,38 1 was a retrospective cohort study, 35 2 were randomized control studies, 36,40 and 1 was a quasi-randomized clinical trial. 37…”

“…34e38, 40 The remaining study had trained community paramedics make home visits. 40 Three studies delivered interventions primarily in the ED/hospital, 35,38,39 one primarily in the home setting, 40 and the remaining 3 used a mix of home and community follow-ups. 34,36,37 Multiple personnel were involved in intervention delivery, including geriatric trained physicians, 34,35,37,38 case management staff (eg, social workers), 34e36 nurses, 34,35,37 and occupational therapists.…”

“…Of the 7 studies, 1 only reported patient outcomes but did not have a comparison group or timeframe. 38 Five studies explicitly measured ED revisits as a primary or secondary study outcomedmost included a 30-day time point, 35,37,39,40 but studies also assessed ED revisit rates at 14 days 40 and 3 months. 34 The primary outcome in 1 study was adherence to outpatient recommendations, 38 and another used a continuous measure of days spent at home in the 90 days following discharge.…”