A geriatric-centred emergency department (ED) observation unit (Geri-EDOU) has improved patient outcomes by using a variety of designs that enable comprehensive geriatric assessment (CGA) for older adults admitted to EDs, reports a Singapore study.
“Our systematic review highlights the role of Geri-EDOUs in addressing the growing demands of ageing ED populations,” said the investigators, who searched seven databases for relevant articles from inception to 16 December 2024.
Studies describing the implementation of Geri-EDOUs with CGA for managing older patients aged ≥65 years were included. The investigators then synthesized study characteristics and clinical outcomes such as length of stay (LOS), hospital admission, discharge and readmission rates, ED reattendance rates, and mortality. They also performed a meta-analysis where appropriate.
A total of 5,656 titles and abstracts were screened, of which 14 met the eligibility criteria. Three models of Geri-EDOUs were identified, with diverse patient profiles and diagnosis categories, unit staffing, patient selection, and CGA components. [Singapore Med J 2026;67:199-210]
Type 1 Geri-EDOUs were short duration (24‒72 h) units located in the ED, type 2 functioned as a transitional clinical decision-making zone connected to or within the ED, and type 3 served as specialist units located downstream of the ED within the acute hospital.
Implementation of Geri-EDOUs resulted in shorter LOS and lower hospital admission and readmission rates. In the meta-analysis, pooled results showed a mean LOS of 2.82 days, a 9-percent mortality rate, 50-percent fewer admissions, and a 30-day ED readmission rate of 11 percent.
Furthermore, double-arm studies found no significant differences in mortality, readmission rates, or admissions saved.
Domains
“International guidelines recommend that, in the emergency setting, older adults at risk should be assessed in the following domains: falls and functional status, frailty, cognitive dysfunction including delirium, medication safety and elder abuse,” the investigators said. [https://www.bgs.org.uk/resources/resource-series/silver-book-ii]
“Not all components were mentioned in the studies,” they added. [https://www.acep.org/siteassets/sites/geda/media/documnets/geda-guidelines.pdf]
Medication reconciliation proves beneficial in Geri-EDOUs, since atypical presentations may arise in older adults from inappropriate medications, polypharmacy, and prescribing cascades. [Drugs Aging 2024;41:833-846; Clin Interv Aging 2014;9:2079-2086]
Unfortunately, pharmacist availability remains inconsistent, and only a few studies reported their presence. [Acad Emerg Med 2018;25:76-82; Clin Med (Lond) 2016;16:19-24]
“The EDOUs may consider obtaining in-reach pharmacist support or developing institution-appropriate triggers for pharmacist consultation and counselling,” the investigators said.
Mental health
Likewise, only a minority of studies mentioned mental health or mood screening, which is distinct from cognition screening. [Aging Clin Exp Res 2011;23:217-222; Rev Espanola Geriatr Gerontol 2009;44:175-179; Australas J Ageing 2012;31:40-46; Eur Geriatr Med 2012;3:261-263; Age Ageing 2014;43:109-114]
Mental health problems among older adults are prevalent but rarely recognized. Depression has been shown to increase healthcare utilization, thus its detection as part of CGA may help to lower ED reattendances. [Age Ageing 2014;43:109-114; BMC Geriatr 2024;24:809; Annu Rev Clin Psychol 2009;5:363-389; BMC Public Health 2024;24:385; Acad Emerg Med 2019;26:878-888]
“Future research should aim to include patient-reported outcomes and cost-effectiveness and explore scalable strategies to increase the reach of CGA in and immediately downstream from the ED,” the investigators said.