The health-related quality of life (HRQoL) of older patients in the emergency department (ED) has significantly improved following their participation in the case management for at-risk patients in the ED (CARED) programme, with the greatest benefit seen among those with no-to-mild frailty, according to a Singapore study.
Furthermore, “[i]ndividuals with greater frailty demonstrated consistently lower HRQoL and limited responsiveness, indicating persistent deficits in daily functioning,” the investigators said. “Male sex emerged as the sole independent risk factor for poorer postintervention HRQoL outcomes, suggesting the need for sex-sensitive care strategies.”
The study employed a quasi-experimental pre‒post design, with participants recruited from the ED over 6 months as part of the CARED programme. Case managers verified demographic and medical details and performed a geriatric assessment incorporating the Clinical Frailty Scale (CFS; version 2.0).
The investigators administered the EQ-5D-5L at baseline and repeated at 3 months after CARED. They then conducted the following analyses: chi-square test, Mann‒Whitney U test, Wilcoxon signed-rank test, and logistic regression (α=0.05).
Some 151 participants (mean age 77.4 years, 75.5 percent female) formed the final sample, most of whom had no-to-mild frailty (80.1 percent), while the rest had moderate-to-very severe frailty (19.9 percent). [Singapore Med J 2026;67:232-240]
Significant improvements across EQ-5D-5L scores and domains were seen in the overall cohort and in older patients with no-to-mild frailty following the CARED programme (p<0.001), but improvements among those with greater frailty were limited.
In comparisons between groups, the investigators saw significantly poorer HRQoL at baseline and follow-up among patients with greater frailty, particularly in mobility, self-care, and usual activities (p<0.05).
Male patients
Notably, male sex was found to be a sole independent risk factor for low post-CARED EQ-5D-5L index scores (adjusted odds ratio, 3.14, 95 percent confidence interval, 1.40–7.00), indicating a higher likelihood of poorer postintervention outcomes among older male patients.
Specifically, men were three times more likely to have poor HRQoL than women after going through the CARED intervention, showing a noticeable disparity between sexes. Such disparity may have been driven by differences in health-seeking behaviour, functional decline trajectories, and psychosocial coping mechanisms, according to the investigators.
Previous studies have shown that older men are less inclined to report symptoms or access support services, potentially delaying care initiation and recovery. They also experience faster deterioration in mobility and self-care, contributing to lower perceived HRQoL and responsiveness to postdischarge interventions. [BMC Public Health 2016;16(suppl 3):1028; Ageing Int 2022;47:705-723]
Moreover, older men tend to have lower emotional self-awareness and be reluctant in seeking psychological assistance, potentially reducing their coping capacity and perpetuating negative health perceptions. [J Long-Term Care 2025;2025:256-268]
“These findings highlight the potential value of tailored, frailty-stratified interventions in supporting health recovery and enhancing QoL within transitional care models,” the investigators said. “Future research should explore long-term HRQoL trajectories and psychosocial mediators across diverse older populations.”
The CARED programme offers “targeted case management for frail older adults and frequent ED reattenders via comprehensive geriatric assessment, multidisciplinary care planning and coordinated discharge support,” according to the investigators.
“Multidisciplinary care at ED includes physiotherapy, occupational therapy, pharmacy review, medical social work, and diabetic and respiratory nurse education, with each component tailored to the individual needs of the patient,” they said.