Early geriatric evaluation and management services reduced in-hospital mortality risk among frail oldest-old patients

Background/Purpose: Geriatric evaluation and management (GEM)-based intervention has been a well-established approach for frail older patients, but whether delayed GEM introduction during the hospital course jeopardizes clinical outcomes remained unclear. Methods: Data of all patients admitted to the GEM unit (GEMU) of Taipei Veterans General Hospital via the emergency department (ED) from January of 2015 to January of 2019 were obtained for study. Patients were categorized into early and delayed GEM two groups. Demographic characteristics and results of functional assessments were used for analysis. All patients were followed by telephone at the first and sixth month after GEMU discharges. Mortality and functional declines during the follow-up period were used as main outcome indicators for this study. Results: Overall, data of 194 patients (median (interquartile range,IQR) age: 91 (87-94) years, 72.2% males) were obtained for analysis and their baseline characteristics were similar between groups. Delayed GEM group (n=32, median (IQR) age: 91.0 (87.5-95.5) years, 75% males) had significantly lower Barthel Index (median (IQR): 0 (0-28) v.s. 25 (0-65), P=0.015) than early GEM group (n=162, median (IQR) age: 91.0 (87.0-94.0) years, 71.6% males), and higher risk for pressure sore (Braden Scale, median (IQR): 13 (12-16) v.s. 15 (13-18), P=0.01). GEM services successfully secure patients in both groups from in-hospital functional declines. Besides, the delayed GEM group had a significantly higher in-hospital mortality rate than the early GEM group (15.6% v.s. 4.9%, P=0.027). Conclusion: Frail elderly patients with acute conditions receiving early GEM services had significantly lower in-hospital mortality risk than delayed GEM group. Further intervention study is needed to establish optimal service model for frail oldest-old patients.