TOPLINE:

A nurse-led comprehensive geriatric assessment in the emergency department (ED) reduced hospital admissions by 11.6% for older adults, without extending ED stays or boosting return visits, a recent study revealed.

METHODOLOGY:

• Researchers conducted a quasi-experimental study from 2021 to 2024, assessing 2731 ED patients aged 65 years or older with an Emergency Severity Index between 2 and 5.
• Participants were divided into two groups: the intervention group (n = 1119) and the control group (n = 1612), which received usual ED care.
• The primary intervention was a modified comprehensive bedside geriatric assessment (mCGA) led by a nurse practitioner; the assessment included screening tools for cognitive, functional, and social connectedness needs; medical chart review; bedside evaluation; and outreach to family or primary care providers.
• The primary outcome was hospital admission rates, and secondary outcomes were ED length of stay (in hours) and ED revisits — either within 72 hours of discharge (including after inpatient admission) or within 30 days of discharge.

TAKEAWAY:

• Implementation of mCGA was associated with an 11.6% reduction in hospital admissions (95% CI, -16.4 to -6.8); however, no significant associations were found with ED length of stay or ED revisit rates at 72 hours or 30 days. These findings were consistent across age groups, biological sex, and verbal English proficiency.
• mCGA with social work showed the largest benefit, reducing hospital admissions by 25.0% (95% CI, -37.0 to -13.0), whereas the pharmacy intervention was associated with a 12.3% increase in admission rates (95% CI, 5.0-19.5).
• Women showed a statistically significant reduction (-4.4%; 95% CI, -8.7 to -0.1) in 30-day ED revisits associated with mCGA.

IN PRACTICE:

"Our intervention, consisting of a mCGA and the potential addition of social work and pharmacy assessments, was associated with a meaningfully lower level of hospital admissions without evidence of negative unintended consequences — overall and within varied patient subgroups," the authors wrote. "These findings add to the growing evidence demonstrating that GEDs [geriatric EDs] can deliver important benefits equitably for older adults as a growing demographic presenting to ED services," they added.

SOURCE:

The study was led by Julia Adler-Milstein, PhD, University of California, San Francisco. It was published online on August 21, 2025, in Annals of Emergency Medicine.

LIMITATIONS:

The nonrandomized design of the study may have introduced selection bias in mCGA allocation, despite propensity score adjustment. The single-center academic ED setting limited the generalizability of the findings. The use of the clinical decision unit was excluded as an outcome because of its complex relationship with receipt of the intervention.

DISCLOSURES:

This study was supported by the Ray and Dagmar Dolby Family Fund. One author reported being a paid consultant for the Institute for Healthcare Improvement Age-Friendly Health System.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.