***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES A two-stage intervention comprising screening and a brief st and ardized nursing assessment and referral , for emergency department ( ED ) patients aged 65 years and over , reduced the rate of functional decline four months after the visit , without increasing societal costs . In this study , the authors investigated the effects of the intervention on the process of care at , and during the month after , the ED visit . METHODS Patients at four Montreal hospital EDs were r and omized by day of visit to the intervention or to usual care . Patients admitted to the hospital were excluded . Measures of process of care included : referrals and visits to the primary physician and to the local community health center , for home care or other services , and return ED visits . Data sources included hospital charts , patient question naires , and provincial administrative data bases . RESULTS The study sample included 166 intervention and 179 control group patients ready for discharge from the ED . Intervention group patients were more likely to have a chart-documented referral to their local community health center [ adjusted odds ratio ( OR ) 4.0 , 95 % confidence interval ( 95 % CI ) = 1.7 to 9.5 ] and their primary physician [ adjusted OR 1.9 , 95 % CI = 1.0 to 3.4 ] , and to have received home care services one month after the ED visit [ adjusted OR 2.3 , 95 % CI = 1.1 to 5.1 ] . Unexpectedly , they were also more likely to make a return visit to the ED [ adjusted OR 1.6 , 95 % CI = 1.0 to 2.6 ] . CONCLUSIONS The beneficial outcomes of the intervention appear to result primarily from the early provision of home care rather than early contact with the primary physician OBJECTIVE To describe the characteristics of elderly patients presenting to an emergency department and the outcome for these patients at 90 days . DESIGN Prospect i ve , descriptive study of all patients over 75 years of age presenting in a four week period . Follow-up data were obtained from the case notes , the Registry of Deaths , the Geriatric Assessment Team and , where necessary , contact with the family doctor . SETTING The Department of Emergency Medicine at the Royal Hobart Hospital , Tasmania , in late 1989 . MAIN OUTCOME MEASURES Death or increased dependence as defined by permanent institutionalisation , moving in with family , or more than 90 days inpatient care . RESULTS There were 210 presentations by 191 different patients ; 116 were admitted to our hospital ( 55.2 % ) , and three ( 1.4 % ) to other hospitals . Follow-up data were obtained for all but five patients . At 90 days from first presentation 23 had died ( 12.4 % ) and in a further 19 ( 10.2 % ) their dependence had increased . Risk factors for death were fractured neck of femur or cardiac failure . Risk factors for either death or increased dependence were referral by someone outside the immediate family , neurological disease , cardiac failure , an apparent social/placement problem , and being assessed as needing admission . The strongest predictor was a social problem . Age was not a risk factor . CONCLUSIONS A predictive formula for poor outcome in this group can be derived . However , outcome may not be altered by admission , or intervention . In the elderly , it is quality rather than duration of life which should be paramount in considering the benefits of therapy AIM To describe and test a model for structured nursing assessment and intervention to older people discharged from emergency department ( ED ) . BACKGROUND Older people recently discharged from hospital are at high risk of readmission . This risk may increase when they are discharged straight home from an ED as time pressure requires staff to focus on the presenting problem although many have complex , unresolved , care needs . METHOD A prospect i ve descriptive pilot study was conducted . Older people aged 70 and over and at risk of adverse health and functional outcome were included . INTERVENTION At discharge , and at 1 and 6 months follow-up , a brief st and ardised nursing assessment ( ISAR 2 ) developed by McCusker et al. was carried out . The focus was on unresolved problems that required medical or nursing intervention , new or different home care services or comprehensive geriatric assessment . After assessment , the nurse made relevant referrals to the geriatric outpatient clinic , community health centre , general practitioner or made arrangements with next of kin . RESULTS One hundred and fifty people participated , mean age was 81.7 . At discharge , they had a mean of 1.9 unresolved problems , after 1 month 0.8 , and after 6 months 0.4 .  Older people receiving home care services increased from 79 % at discharge to 89 % at 1 month and 90 % at 6 months follow-up . CONCLUSION ISAR 2 works well in a Danish ED setting and intercepts older peoples ' problems . It seems that unresolved problems decrease when a nurse assesses and intervenes at discharge from ED , and at follow-up . However , a r and omised controlled test should be carried out to confirm this . IMPLICATION S FOR PRACTICE Nursing assessment and intervention should be implemented in the ED to reduce older peoples ' unrevealed problems OBJECTIVES To determine the effectiveness of a two-stage ( screening and nursing assessment ) intervention for older patients in the emergency department ( ED ) who are at increased risk of functional decline and other adverse outcomes . DESIGN Controlled trial , r and omized by day of ED visit , with follow-up at 1 and 4 months . SETTING Four university-affiliated hospitals in Montreal . PARTICIPANTS Patients age 65 and older expected to be released from the ED to the community with a score of 2 or more on the Identification of Seniors At Risk ( ISAR ) screening tool and their primary family caregivers . One hundred seventy-eight were r and omized to the intervention , 210 to usual care . INTERVENTION The intervention consisted of disclosure of results of the ISAR screen , a brief st and ardized nursing assessment in the ED , notification of the primary care physician and home care providers , and other referrals as needed . The control group received usual care , without disclosure of the screening result . MEASUREMENTS Patient outcomes assessed at 4 months after enrollment included functional decline ( increased dependence on the Older American Re sources and Services activities of daily living scale or death ) and depressive symptoms ( as assessed by the short Geriatric Depression Scale ) . Caregiver outcomes , also assessed at baseline and 4 months , included the physical and mental summary scales of the Medical Outcomes Study Short Form-36 . Patient and caregiver satisfaction with care were assessed 1 month after enrollment . RESULTS The intervention increased the rate of referral to the primary care physician and to home care services . The intervention was associated with a significantly reduced rate of functional decline at 4 months , in both unadjusted ( odds ratio ( OR ) = 0.60 , 95 % confidence interval ( CI ) = 0.36 - 0.99 ) and adjusted ( OR = 0.53 , 95 % CI = 0.31 - 0.91 ) analyses . There was no intervention effect on patient depressive symptoms , caregiver outcomes , or satisfaction with care . CONCLUSION A two-stage ED intervention , consisting of screening with the ISAR tool followed by a brief , st and ardized nursing assessment and referral to primary and home care services , significantly reduced the rate of subsequent functional decline The aim of this r and omised controlled trial involving 224 elderly patients was to determine whether early geriatric assessment ( in the form of an aged care nurse intervention based in the emergency department ) reduced admission to the hospital , length of inpatient stay ( LOS ) , or functional decline during the hospitalisation . Baseline  geriatric assessment  s were recorded in the medical files of intervention patients ( n = 114 ) . The nurse also liaised with the patients ' carers and health care providers , organised referrals for out-of-hospital assessment and support services , and assisted in the care of those admitted as in patients by documenting suggestions for assessment and referral . Assessment data from  control patients ( n = 110 ) were withheld , and the nurse had no further involvement in their inpatient or outpatient care . One hundred and seventy-one patients ( 76 % ) were admitted to the hospital , for a median LOS of 10 days . The nurse successfully identified those needing admission ( odds ratio [ OR ] , 14.0 ; 95 % confidence interval [ CI ] , 2.6 - 75.1 ) . Thirty-nine of 160 in patients with available data ( 24 % ) had a functional deterioration during the hospitalisation . The intervention had no significant effect on admission to the hospital ( OR , 0.7 ; CI , 0.3 - 1.7 ) , LOS ( hazard ratio , 1.1 ; CI , 0.7 - 1.5 ) or functional decline during the hospitalisation ( OR , 1.3 ; CI , 0.5 - 3.3 ) STUDY OBJECTIVE Elderly emergency department patients have complex medical needs and limited social support . A transitional model of care adapted from hospitals was tested for its effectiveness in the ED in reducing subsequent service use . METHODS A r and omized clinical trial was conducted at 2 urban , academically affiliated hospitals . Participants were 650 community-residing individuals 65 years or older who were discharged home after an ED visit . Main outcomes were service use rates , defined as repeat ED visits , hospitalizations , or nursing home admissions , and health care costs at 30 and 120 days . Intervention consisted of comprehensive geriatric assessment in the ED by an advanced practice nurse and subsequent referral to a community or social agency , primary care provider , and /or geriatric clinic for unmet health , social , and medical needs . Control group participants received usual and customary ED care . RESULTS The intervention had no effect on overall service use rates at 30 or 120 days . However , the intervention was effective in lowering nursing home admissions at 30 days ( 0.7 % versus 3 % ; odds ratio 0.21 ; 95 % confidence interval [ CI ] 0.05 to 0.99 ) and in increasing patient satisfaction with ED discharge care ( 3.41 versus 3.03 ; mean difference 0.37 ; 95 % CI 0.13 to 0.62 ) . The intervention was more effective for high-risk than low-risk elders . CONCLUSION An ED-based transitional model of care reduced subsequent nursing home admissions but did not decrease overall service use for older ED patients . Further studies are needed to determine the best models of care for this setting and for at-risk patients OBJECTIVES To study the effects of comprehensive geriatric assessment ( CGA ) and multidisciplinary intervention on elderly patients sent home from the emergency department ( ED ) . DESIGN Prospect i ve , r and omized , controlled trial with 18 months of follow-up . SETTING Large medical school-affiliated public hospital in an urban setting in Sydney , Australia . PARTICIPANTS A total of 739 patients aged 75 and older discharged home from the ED were r and omized into two groups . INTERVENTION Patients r and omized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team . The team implemented or coordinated recommendations . The control group received usual care . MEASUREMENTS The primary outcome measure was all admissions , to the hospital within 30 days of the initial ED visit . Secondary outcome measures were elective and emergency admissions , and nursing home admissions and mortality . Additional outcomes included physical function ( Barthel Index ( total possible score=20 ) and instrumental activities of daily living ( /12 ) and cognitive function ( mental status question naire ( /10 ) ) . RESULTS Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit ( 16.5 % vs 22.2 % ; P=.048 ) , a lower rate of emergency admissions during the 18-month follow-up ( 44.4 % vs 54.3 % ; P=.007 ) , and longer time to first emergency admission ( 382 vs 348 days ; P=.011 ) . There was no difference in admission to nursing homes or mortality . Patients r and omized to the intervention group maintained a greater degree of physical and mental function ( Barthel Index change from baseline at 6 months : -0.25 vs -0.75 ; P<.001 ; mental status question naire change from baseline at 12 months : -0.21 vs -0.64 ; P<.001 ) . CONCLUSION CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital . Patients aged 75 and older should be referred for CGA after an ED visit We prospect ively examined the care provided to 234 elderly patients ( age greater than or equal to 65 ) and an equal number of nonelderly patients visiting the emergency department of an urban teaching hospital .  Sociodemographic , treatment , cost , and outcome data were collected through ED record review s and follow-up telephone interviews .  The elderly comprised 19 % of the ED population and were often nonwhite ( 31 % ) , Medicaid recipients ( 39 % ) , living alone ( 41 % ) , and multiply and chronically impaired . Among old-old patients ( age greater than or equal to 75 ) , the most frequent reasons for visiting the ED ( 19 % ) were a self-care problem , a fall , or dehydration . Forty-five percent of old-old patients ' visits were for true medical emergencies or urgencies . Compared to the nonelderly , the old-old more often were admitted ( 47 % versus 1 
    Output:
    
Two trends surfaced : ( i ) more intensive interventions more frequently result ed in reduced adverse outcomes than did simple referral intervention types ; and ( ii ) among the lowest intensity , referral‐based interventions , studies that used a vali date d prediction tool to identify high‐risk patients more frequently reported improved outcomes than those that did not use such a tool .
Despite this , more intensive interventions that followed patients beyond a referral and the use of a clinical risk prediction tool appeared to be associated with improved outcomes .