Community Specialist Teams for Older Persons (CST-OP) at risk of, or living with frailty in Ireland: a prospective cohort study of a new model of integrated care for community dwelling older adults

Community Specialist Teams for Older Persons (CST-OP) at risk of, or living with frailty in Ireland: a prospective cohort study of a new model of integrated care for community dwelling older adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Community Specialist Teams for Older Persons (CST-OP) at risk of, or living with frailty in Ireland: a prospective cohort study of a new model of integrated care for community dwelling older adults Christina Hayes, Aoife Whiston, Christine Fitzgerald, Collette Devlin, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5890108/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Jun, 2025 Read the published version in BMC Primary Care → Version 1 posted 10 You are reading this latest preprint version Abstract Background: This study explored the clinical and process outcomes of older adults at risk of or living with frailty who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the community. Methods: This prospective cohort study recruited older adults aged ≥75 who were screened for frailty and referred to one of three CST-OP hubs in the Mid-West of Ireland by their GP. Follow-up assessments were conducted via telephone by an independent assessor at 30-and-180 days. The primary outcome was functional status. Secondary outcomes included primary healthcare use, secondary healthcare use, nursing home admission, health-related quality of life (HRQoL), patient satisfaction and mortality. Results: A total of 303 participants (mean age=83.23 years) were recruited. Incidence of 30-and 180-day functional decline was 26.4% and 33.7% respectively. The majority of older adults who availed of community-based CGA maintained functional independence up to 6-months post index visit. At 30 days, the mortality rate was 1%, Emergency Department (ED) presentation 6.9%, hospitalisation 6.6% and nursing home admission 4%. HRQoL significantly improved at 30-and-180 days. There was a significant improvement in HRQoL, F(2, 542)=13.839, p<0.001, η 2 =0.49. The presence of frailty was a significant predictor of adverse outcomes. Conclusion: Community-based CGA results in favorable health outcomes including HRQoL among community-dwelling older adults. Community-based CGA may also mitigate against potentially avoidable ED presentations and hospitalisations. Use of the Clinical Frailty Scale is recommended to predict the risk of functional decline, increased rates of mortality, NH admission, hospitalisation or ED presentation at 30 and 180 days among community-dwelling older adults. Trial registration : The study protocol was prospectively registered on Clinicaltrials.gov (NCT05527223). Registered January 09, 2022. https://clinicaltrials.gov. Comprehensive geriatric assessment community out-patient older adults community-dwelling frailty Background The proportion of older adults is increasing rapidly worldwide (1). There is a particularly fast growth in the oldest old, with number of adults aged over 85 years expected to increase by 95.5% by 2031 (2). As people age, they experience a decline in their intrinsic capacity, ultimately leading to more chronic and complex health issues (3), increased care dependency and increased susceptibility to frailty (4, 5). Frailty, a consequence of age related decline in multiple physiological systems commonly resulting in heightened vulnerability to sudden health changes, placing older adults at increased risk of poor health outcomes (5, 6). Community-dwelling older adults living with frailty are additionally at increased risk of reduced health-related quality of life (HRQoL) (7), functional decline (8), increased rate of hospitalisation (8), nursing home (NH) admission (9) and mortality (10) compared to their non-frail community-dwelling older adults . With a quarter of adults aged over 75 years, and over half of adults aged 85 years living with frailty (4, 5, 11), intervening at an early stage of developing frailty is a priority across health systems internationally (1). However, realigning health and social care systems to deliver care to older adults is challenging in the context of an ageing population globally(3). As such, integrated care strategies targeting enhanced health outcomes and HRQoL for older adults are an increasing focus of health policy and service delivery (3). Integrated care is a person centred model of care whereby services that span across the different levels and sites of care are co-ordinated and integrated according to an individual’s needs (3). Varied models of integrated care exist, underpinning the complexity of its implementation (12). The World Health Organization (WHO) guidelines for integrated care for older people do however, recommend a holistic assessment, a common goal and a care plan for older adults with particular focus on early intervention within the community setting (1, 3). Integrated care strategies for older adults has demonstrated reduced rates of hospitalisations, length of hospital stay and improved patient satisfaction (13). Two of the challenges of integrating healthcare, according to older adults receiving community services, are fragmented communication strategies by healthcare professionals and a discontinuity of care while transitioning across care settings (14). This is further highlighted in the output of a recent Priority Setting Partnership with the James Lind Alliance, where improving the exchange of information between specialist/acute and primary care services within the Irish setting was reported as the top research priority in managing chronic conditions in primary care (15). In order to facilitate integrated healthcare reform in Ireland, the national Integrated Care Programme for Older People has implemented a number of initiatives to facilitate a shift away from acute episodic care to longitudinal coordinated and integrated care for older adults that allows them to access care closer to home (16). One such approach is the establishment of community specialist teams for older people (CST-OP) whereby experienced multidisciplinary team (MDT) individuals from medical, nursing, pharmacy and health and social care professions offer prompt comprehensive geriatric assessment (CGA) in the community to older adults (16, 17). CGA is defined as a multidimensional approach to assessment of an older adults medical, psychological, functional ability and social circumstances in order to develop a personalised coordinated and integrated plan for treatment and follow-up (18). The research evidence base reports mixed results to support the effectiveness of CGA in the community setting (19). A recent Cochrane review and meta-analysis of 21 randomised controlled trials (RCT) examining the effectiveness of community-based CGA (including within the participant’s home, general practice, or community-based clinic) for community-dwelling frail older adults found no improvement in functional status (standardised mean difference (SMD): -0.09; 95% CI: −0.24 to 0.05) and little change in the health related quality of life (HRQoL) (SMD: 0.10; 95% CI: 0.00–0.21) among this cohort (19). However, there was heterogeneity across studies with regards to the description of ‘CGA’ interventions delivered. Given the uncertainty of community-based CGA and the variations in its operation, this review called for future research to examine its effectiveness (19). Furthermore, the WHO called for future longitudinal research to investigate profiles of older adult’s functional abilities and healthcare needs in order to realise the goal of Healthy Ageing (20). The heterogeneity of person-centred outcomes and lack of a core outcome set incorporating patient-reported outcome measures (PROMs) across community-based CGA research (19, 21, 22) has led to a lack of robust evidence to support its effectiveness. Implementation of PROMs that enable collaborative person-centred interventions ensure more effective healthcare (23). This prospective cohort study is the first study nationally to explore the process, clinical and patient-reported outcomes of older adults over a 6-months period, who are referred to one of the three CST-OP hubs in the Mid-West of Ireland by their GP. Methods Study design This prospective cohort study was conducted in line with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines (Additional File 1) (24). Data collection and follow-up took place during the period of February 2022 to December 2023 (inclusive). The study protocol was registered on Clinicaltrials.gov (NCT05527223). Registered January 09, 2022. https://clinicaltrials.gov. Ethics Ethical approval for the study was granted by the Research Ethics Committee, University of Limerick Hospitals Group, Mid-West Region (Ref. 116/2021). Setting This multi-site study took place at three CST-OP hubs across the Mid-West region. Each of these hubs serve an approximate population of 150,000 people and has a population of approximately 34,000 people living with a chronic disease (25). The CST-OP multidisciplinary team comprised specialist geriatrician, nursing and allied health disciplines. This team was operational from 8:00-17:00 Monday-Friday. A typical detailed description of the referral, assessment and closure process at the CST-OP is available in appendix 5 of the “Practice Guidance for Older-Person Multidisciplinary Teams” (26). Referrals were sent by GPs directly to the CST-OP. All referrals received by the CST-OP were triaged by a member of the MDT and geriatrician. All participants who were assessed in-person by their GP and met inclusion criteria were considered eligible. A detailed description of the MDT composition across the three sites is outlined in Table 1. Table 1 Multidisciplinary team composition at each CST-OP CST-OP Site 1 CST-OP Site 2 CST-OP Site 3 Data collection period February 2022- January 2023 June 2022- April 2023 May 2022- June 2023 Geriatrician (FTE) 0.5 0.5 FTE June-Dec 2022. 1 FTE from June 2023 onwards 0.5 FTE May - Dec 2022 Varied locum medical agency cover December 2022 onwards CNS (FTE) 1 1 1 ANP (FTE) 2 2 1 Senior Physiotherapist (FTE) 1 1 1 (Maternity leave from July 22- March 23) agency cover for small period of this time) Physiotherapy assistant (FTE) 1 1 August 2023 onwards 1 Senior Occupational Therapist (FTE) 1 1 0 Senior Speech and Language Therapist (FTE) 0.5 1 May 2023 onwards Senior Dietician (FTE) 1 (Was on leave for part of study) 0.5 0.5 Other Registrar GP Case Manager OTA 1 1 1 0 1 Abbreviations : FTE, full-time equivalent; CNS, clinical nurse specialist; ANP, advanced nurse practitioner; GP, General Practitioner; OTA, occupational therapist assistant Population of Interest and recruitment All older adults aged ≥75 years who were referred to the CST-OP hub by their GP during recruitment periods were considered eligible for participation in the study, if they met the following inclusion/exclusion criteria: Inclusion criteria Patients aged ≥75 years who were referred to the CST-OP hub by their GP, scored between 4 and 6 on the Rockwood Clinical Frailty Scale (CFS) (27)(pre-frail, mildly frail or moderately frail), resided within the catchment area of the relevant CST-OP hub, had been assessed in-person by the referrer, did not have community MDT input within the last three months. And any one of the following criteria: Fall within the last month unrelated to acute cardiac or neurological cause and no previous falls assessment, increased dependency or increased carer burden in the last month, a deterioration in swallow in the previous month including symptoms of recurrent chest infections, weight loss, coughing when eating/drinking, self-modifying diet secondary to difficulties or experienced an adverse drug reaction within the last month excluding allergic reaction. Exclusion criteria Patients were excluded if they presented with an acute neurological or cardiovascular event, were more appropriate to an alternative care pathway or service e.g. primary care or geriatric medicine clinic, presented with injuries, unless the injury had already been appropriately managed, were experiencing an acute medical illness requiring treatment in an acute hospital setting, if care was being provided by other health care professionals at the time of referral and it was apparent that they are working to meet goals aligned with that current service, they required investigation or treatment not available in the relevant CST-OP hub (unless these investigations are already being arranged elsewhere), they have had MDT input in the previous three months, had confirmed or suspected Covid-19 infection or other exclusions at the discretion of the CST-OP based on clinical expertise and available resource. Consecutive participants were identified by a member of the MDT. It was assumed that participants had the ability to consent or decline participation unless the research nurse determined they lacked capacity. The research nurse explained the study to the potential participant. If an older adult was able to understand, retain, and articulate the details of the study to the research nurse, and could assess the information to make an informed decision, their capacity was considered intact. If a participant could not demonstrate these abilities, they were regarded as lacking the capacity to consent, and proxy consent was obtained from the next of kin, with the patient's assent. The next of kin was given time to review the study and ask questions on the patient’s behalf. Hard copies of signed participant consent forms were stored in a locked filing cabinet in a locked office on-site. Exposure All participants underwent a CGA which was initiated at index visit to the CST-OP hub. A medical assessment including medication review, blood pressure and physical assessment was led by the geriatrician. A falls assessment, assessment of mobility and stairs, transfers, personal care, activities of daily living (ADLs), social supports and environmental, cognition, and nutritional assessments were conducted by a member of the MDT. Personalised goals were discussed with patients to inform the care plan. The geriatrician oversaw the medical management of all participants. The MDT then created a clinical problem list based on the patient’s presentation and created a recommended plan of care which was discussed at a weekly MDT meeting. Diagnostic procedures (e.g. DXA scan, Tilt Table testing, ECG, 24-hour ambulatory blood pressure monitoring) were carried out at the hub or relevant hospital where required. Patients received out-patient medical, allied health professional or nursing input over a period of up to six weeks or dependent on the patient’s ongoing needs. Patients were also referred to other community-based services including public health nurse, home healthcare or specialist out-patient / in-patient care etc. where appropriate. Referrals to voluntary social support services for older adults were also initiated where relevant. Patients were discharged when their duration of care concluded, as determined by the geriatrician and were discharged back to their GP. Consistent with the components of CGA reported by Ellis and colleagues (18), the fundamental components of CGA adopted are outlined in Additional File 2. Baseline data collection Baseline consent and assessments were completed by members of the CST-OP. The baseline assessment comprised of demographic variables and validated health measures. Demographic information included participant’s age, sex, ethnicity, marital status, residential status, socioeconomic status, education level and living circumstances were recorded. The health assessment included: presenting problem, smoking status, alcohol consumption, mobility status, 12-month self-report falls history, co-morbidities (Charlson Co-morbidity index), global measure of function (Barthel Index), frailty status (CFS) and quality of life (EuroQoL-5D-5L). Follow-up data collection Participants were followed-up via telephone call at 30-days and 6-months post index visit by an independent member of the research team (CH or CD) who were not involved in the patients routine care. Data on objective and health measures including: ED presentation, Acute Medical Assessment Unit attendance, hospitalisation, NH admission, incidence of falls, functional status (Barthel Index), mortality, use of geriatric services, use of other primary care services during this timeframe, participant satisfaction with care (Patient Assessment of Integrated Elderly Care) and quality of life (EQ5D5L) were recorded. Outcomes Primary outcome- functional status at baseline, 30 days and 6 months, as measured by the Barthel Index (28). Primary healthcare use (within and outside of CST-OP healthcare utilisation). This included the number of services that participants were in receipt of following index visit at the CST-OP hub including; GP visits, Public Health Nurse visits, Health and Social Care Professional use, formal homecare support at 30-days and 180-days. Secondary healthcare utilisation. This included the number of secondary healthcare services that participants were in receipt of including; Outpatient services, ED presentation and unplanned hospital admission at 30-days and 180-days. Patient satisfaction. Participants evaluated the quality of integrated care across a number of domains using the Patient Assessment of Integrated Elderly Care (PAIEC) Questionnaire at 30-days. Quality of life: Participants rated their HRQoL using the EuroQoL-5D-5L (29) at 30-days and 6-months. Mortality: The number of participants who died following their index visit at the CST-OP hub 30-days and 180-days. Nursing home admission: Number of participants who were admitted to a nursing home or residential care facility following their index visit to the CST-OP hub 30-days and 180-days. Sample size Our study was not hypothesis driven; therefore, formal power calculations were not applicable. All prospective older adults that met inclusion criteria were invited to participate during the study recruitment period (January 2022-2023 inclusive). Statistical analysis Descriptive statistics were used to profile the baseline characteristics of the cohort. Categorical data (e.g. biological sex) were analysed using frequencies and percentages. Continuous data (e.g. age) were analysed using means and standard deviations (SD) or median and interquartile ranges (IQR) where data demonstrated evidence of skewness (e.g. BI). One-way within-subjects ANOVAs were conducted to examine differences in functional status (Barthel Index) and HRQoL (EQ5D5L) across timepoints – index, 30 days, and 180 days. Separate multivariate logistic regressions were conducted to explore predictors of adverse outcomes at 30 and 180-days. Multimorbidity (30) and frailty (31, 32) are predictors for adverse outcomes for older adults. Based on previous research, frailty, age, biological sex, falls at baseline, presence of co-morbidities and number of interventions received from the CST-OP were the predictors explored. For all logistic regression models, odds ratios with 95% odds ratio scale CIs were reported. Relative Risk (RR) and corresponding 95% CIs were calculated to determine the risk of adverse outcomes at 30 days and 180 days at a cut-off score of ³5 on the CFS. A 5% level of significance was used for all statistical tests. All statistical analyses were undertaken using SPSS Version 24. Results A total of 303 participants were recruited from February 2022- June 2023. Demographic and clinical characteristics of the overall sample are presented in Table 2. The mean age of participants was 83.23 years (SD = 5.77) with females representing 67.7% of the total population. The majority of the population were white Irish (99.3%) and almost half were widowed (45.9%) and lived alone (47.2%). The prevalence of frailty, categorised as ³5 on the CFS, was 55.4% (n=168). The most common presenting problem to the CST-OP was due to falls (43.9%), with over half of the cohort experiencing a fall in the 12 months prior to their index visit (58.7%). The median Barthel score was 18 (IQR = 3) and the median CFS score was 5 (IQR = 1) therefore, defined as living with mild frailty. Table 2 Baseline characteristics Total (N= 303) Age, mean ± SD 83.23 (5.77) Female, n (%) 205 (67.7) Ethnicity, n (%) White Irish 301 (99.3) Other white background 1 (0.3) Black Irish 1 (0.3) Marital status, n (%) Married 123 (40.6) In a relationship 1 (0.3) Single 24 (7.9) Widowed 139 (45.9) Separated/divorced 16 (5.3) Residential status, n (%) Lives alone 143 (47.2) Lives with family (spouse) 44 (14.5) Other 116 (38.3) Presenting problem, n (%) Falls 133 (43.9) Reduced Mobility 46 (15.2) Increased Frailty 42 (13.9) Cognitive Impairment 22 (7.3) Dizziness 14 (4.6) Increased dependency 8 (2.6) Unsteady gait 7 (2.3) Hypertension 5 (1.7) Parkinsons 4 (1.3) Syncope 3 (1.0) Vertigo 2 (0.7) Anxiety 2 (0.7) Pain 2 (0.7) COPD 2 (0.7) Functional decline 2 (0.7) Chronic Pain 2 (0.7) Headaches 1 (0.3) Breathlessness 1 (0.3) Post CVA 1 (0.3) Confusion 1 (0.3) Increased carers burden 1 (0.3) Sleep deprivation 1 (0.3) Atrial Fibrillation 1 (0.3) Socioeconomic status, n (%) Affluent 6 (2.0) Marginally above average 125 (41.3) Marginally below average 128 (42.2) Disadvantaged 33 (10.9) Very Disadvantaged 11 (3.6) Living circumstances, n (%) Single storey house 29 (9.6) 2 storey house 165 (54.5) 3 storey house 5 (1.7) Flat ground floor 6 (2.0) Flat above ground 2 (0.7) Bungalow 92 (30.4) Sheltered housing 2 (0.7) Other 2 (0.7) Smoking, n (%) Unknown 1 (0.3) Never 201 (66.3) Active 22 (7.3) Previous 78 (25.7) Occasional 1 (0.3) Alcohol, n (%) Unknown 1 (0.3) Never 163 (53.8) Active 58 (19.1) Previous 30 (9.9) Occasional 51 (16.8) History of falls in past 12-months, n (%) 178 (58.7) Barthel Index, median (IQR) 18 (3) CFS median (IQR) 5 (1) EQ-5D-5L Index Value, median (IQR) 0.68 (0.42) Mobility, median (IQR) 2 (1) Self-care, median (IQR) 1 (2) Usual activities, median (IQR) 2 (2) Pain, median (IQR) 2 (1) Anxiety, median (IQR) 2 (2) EQ-5D-5L visual analog scale, median (IQR) 70 (30) Charlson comorbidity index, median (IQR) 3 (3) Note: Median and IQR are presented where data are not normally distributed Outcomes at 30 days Incidence of functional decline was reported at 26.4% (n=80) across the overall number of participants as measured by the BI. At 30 days the mortality rate was 1% (n=3). Data were unavailable for seven participants on the PAIEC outcome (n=1 declined and n=6 not reported). The average PAIEC score was 82.80 (SD = 1.099). A detailed analysis of the PAIEC is available in Additional File 3. In terms of process outcomes (see Table 3), almost seven percent of the cohort experienced an unplanned ED presentation (6.9%) (n=21), 6.6% experienced an unplanned hospital admission (n=20) and 35.6% had an OPD appointment in the acute setting (n=108). Sixteen percent (n=49) of participants used acute care services. Twelve participants were admitted to a NH (4%). At 30-day follow-up, 13.2% of participants were discharged from the CST-OP (n=40). Table 3 Overall 3-sites 30- and 180- day descriptives Outcome 0 - 30 days 30 – 180 days Died, n (%) 3 (1) 9 (3) ED attendance, n (%) 21 (6.9) 72 (23.8) AMU attendance, n (%) 3 (1) 8 (2.6) MAU attendance, n (%) 2 (0.3) 27 (8.9) LIU attendance, n (%) 3 (1) 10 (3.3) EMS Use 1 (0.3) 3 (1) Hospital admission 20 (6.6) 60 (19.8) Combined acute care use 49 (16.2) 177 (58.4) NH admission, n (%) 12 (4) 31 (10.2) Falls incidence 42 (13.9) 75 (24.8) Functional decline (binary), n (%) 80 (26.4) 102 (33.7) Discharge from CST-OP, n (%) 40 (13.2) 261 (86.1) Primary care service use, n (%) 226 (74.6) 278 (91.7) PAIEC, mean (SD) 82.80 (1.099) - Abbreviations: ED, emergency department; AMU, acute medical unit; MAU, medical assessment unit; LIU, local injury unit; EMS, emergency medical services (ambulance services); NH, nursing home; CST-OP, community specialist team for older people; PAIEC, patient assessment of integrated elderly care. Separate logistic regression models were estimated to explore if baseline characteristics predicted adverse outcomes at 30-day (Table 4). Our pooled data demonstrated that the presence of frailty (measured as ³5 on the CFS) is a significant predictor of functional decline at 30 days OR 1.475 (1.111,1.95), NH admission 2.088 (1.060,4.11), hospitalisation OR 2.213 (1.289, 3.800), ED presentation OR 2.160 (1.309, 3.563), primary care use OR 1.338 (1.004, 1.783) and mortality OR 5.565 (1.328, 23.327) at 30 days. Female biological sex was a significant predictor of higher primary care service use. Table 4 Total Sample Logistic Regression Models Functional decline (binary) NH admission Hospitalisation ED admission PC services Mortality 30 days CFS, OR [CIs] 1.475 (1.111,1.959)* 2.088 (1.060,4.11)* 2.213 (1.289, 3.800)* 2.160 (1.309, 3.563)* 1.338 (1.004, 1.783)* 5.565 (1.328, 23.327)* Age, OR [CIs] 1.001 (0.955,1.048) 1.053 (0.944, 1.174) 1.023 (0.941, 1.112) 0.965 (0.891, 1.046) 1.038 (0.989, 1.089) 1.016 (0.829, 1.246) Biological sex, OR [CIs] 1.013 (0.574, 1.790) 1.367 (0.348, 5.371) 0.360 (0.133, 0.973)* 0.470 (0.184, 1.200) 0.699 (0.380, 1.286) 0.240 (0.018, 3.295) Falls at baseline (12-month hx), OR [CIs] 1.029 (0.596, 1.776) 1.425 (0.396, 5.132) 0.722 (0.267, 1.950) 1.119 (0.428, 2.927) 1.214 (0.695, 2.123) **not applicable Charlson, OR [CIs] 1.006 (0.985, 1.027) 0.956 (0.714, 1.280) 0.915 (0.710, 1.180) 0.996 (0.947, 1.048) 1.138 (0.983, 1.318) 0.769 (0.369, 1.601) 180 days Functional decline (binary) NH admission Hospitalisation ED admission PC services Mortality CFS, OR [CIs] 1.672 (1.254, 2.229)* 1.499 (0.976, 2.303) 1.499 (1.088, 2.067)* 1.577 (1.163, 2.140)* 1.429 (0.874,2.339) 2.618 (1.156, 5.927)* Age, OR [CIs] 1.037 (.991, 1.085) 1.115 (1.037, 1.198)* 1.006 (.955, 1.059) 1.004 (0.957, 1.054) .891 (.815,0.974)* 1.089 (0.957, 1.240) Biological sex 0.772 (0.449, 1.329) 1.092 (.474, 2.514) .97 (.523, 1.833) 0.713 (0.398, 1.278) 0.154 (0.034, 0.697)* 0.748 (0.166, 3.368) Falls at baseline (12-month hx), OR [CIs] 1.166 (0.688, 1.977) 1.517 (0.674, 3.412) 1.220 (0.665, 2.237) .700 (.399, 1.228) 0.515 (.192, 1.379) 0.495 (0.111, 2.211) Charlson, OR [CIs] 0.993 (0.877, 1.125) 1.115 (.939, 1.324) 1.039 (.905, 1.192) 0.951 (0.828, 1.091) 0.988 (0.789, 1.236) 0.961 (.677, 1.364) Note : *p<0.05. **As there were 0 count of falls in the group that did not die, there was not enough power to include falls at baseline (12-month history) in this analysis (33). Abbreviations : CFS, clinical frailty scale; ED, emergency department; NH, nursing home; CST-OP, community specialist team older people; PC, primary care; OR, odds ratio; CI, confidence interval; hx, history. Outcomes at 180 days There was a significant difference in functional status, F (2, 556) = 12.572, p < .001, η 2 = 0.43. Self-reported functional status was maintained at 30-days post index visit 17.64 (2.68) mean (SD), but there was a significant decline at 180-days 17.1 (3.5) mean (SD). The mortality rate was 3% (n=9) at 180 days. The incidence of functional decline was 33.7% (n=102). In terms of process outcomes (see Table 3), 23.8% (n=71) of participants experienced an unscheduled ED presentation, 19.8% (n=60) experienced an unplanned hospital admission, 10.2% (n=31) were admitted to a NH and 53.8% (n=163) had an OPD appointment in the acute setting. Fifty-eight percent (n=177) of participants used acute care services. At 180-day follow-up 86.1% (n=161) were discharged from the CST-OP. Separate logistic regression models were estimated to explore if baseline characteristics predicted adverse outcomes at 180-days (Table 4). Our pooled data demonstrated that the presence of frailty (as measured as ³5 on the CFS) is a significant predictor of functional decline OR 1.672 (1.254, 2.229), NH admission OR 1.499 (0.976, 2.303), hospitalisation OR 1.499 (1.088, 2.067), ED presentation OR 1.577 (1.163, 2.140), and mortality OR 2.618 (1.156, 5.927) at 180-days. Female biological sex and increasing age were significant predictors of higher primary care service use. There was a significant improvement in HRQoL index values between index visit and 30-days 0.7 (0.30) mean (SD) and between index and 180-days 0.68 (SD 0.32) mean (SD), F (2, 542) = 13.839, p < .001, η 2 = 0.49. No significant differences were observed between index and 30-days but there was a significant decline in HRQoL as per the VAS between 30 and 180 days (p=0.04, 95% confidence interval (CI) 0.083-5.672). Multidisciplinary care received by participants The number of interventions provided by the CST-OP allied health professionals is outlined in Additional File 4. Most participants received physiotherapy input (61.1% at 30-days and 64.7% at 180-days). The second most common allied health professional input was SLT at 30-days followed by OT and dietetic input respectively (Additional File 4). Almost 16% of participants received OT input at 180days, 15.5% received speech and language input and 7.9% were seen by a dietician at 180-days (Additional File 4). Community services and integration of healthcare Participants also received care for PCCC services. Almost three quarters of participants used primary care services (n=226) over the 30-day period while 91.7% (n=278) used PCCC services between 30 and 180 days. A detailed breakdown of PCCC use is available in Additional File 5. The number of GP attendances increased from 31% attending the GP between index and 30 days while 69.3% attended the GP between 30-days and 180days. An increase of home help services was also observed (29.7% at 30-days vs 46.2% at 180 days). A low rate of onward referral to routine community allied health professional services was noted across timepoints with 8.3% being referred for PT, 7.9% for OT, 1% for SLT and dietetics at 30-days. Discussion This prospective cohort study explored the clinical and process outcomes of community-dwelling older adults who were screened by and referred to one of three CST-OP hubs in the Mid-West of Ireland by their GP and received CGA, over a period of six months after their initial hub attendance. The presence of frailty (as measured as ³5 on the CFS) was a significant predictor of functional decline, NH admission, hospitalisation, ED presentation, primary care use and mortality at 30 days and of functional decline, hospitalisation, ED presentation and mortality at 180 days. Our findings demonstrate that despite the pre-frail/frail presentation of older adults to the CST-OP hub, functional status was maintained at 30 days. There was, however, a significant reduction in functional status at 180 days. Our findings parallel those of two prospective cohort studies that reported a significant decrease in physical functioning among German and American community-dwelling older adults ≥75 years over time (34, 35). Similarly, our findings are further comparable to the Brazilian PerGERO prospective cohort study of community-dwelling older adults who underwent OPD CGA (36). Seventy-seven percent of participants in this study were living with frailty or pre-frailty and had mean age of 82 years (SD=8). Based on data provided by the main author, over a 12-month follow-up period 20.28% experienced functional decline, 9.88% died, 24.10% were hospitalized, 55.61% attended the ED and 2% were admitted to a NH (36). However, it must be noted that some clinical and methodological differences between this study and our cohort study existed. Namely, this study included some older adults who were not living with frailty, the team composition of this study only included nurses and geriatricians, and it lacked detail on any follow-up intervention procedures post assessment (36). A decline in functional status can be attributed to several factors. At a biological level, ageing is characterised as damage at a molecular and cellular level that ultimately leads to a progressive decline in bodily functions (20). Findings from our prospective cohort study also align with those from a recent Cochrane review of 21 RCTs examining the effectiveness of community-based CGA that found little to no improvement on functional status (SMD −0.09, 95% CI −0.24-0.05) and other clinical and process outcomes including mortality (RR 0.88, 95% CI 0.76-1.02), ED presentations (RR 0.65, 95% CI 0.26-1.59), NH admission (RR 0.93, 95% CI 0.76- 1.14) and little change in HRQoL (SMD 0.10, 95% CI 0.00-0.21 among community-dwelling older adults (19). This review provided data on 7893 older adults across 10 countries and four continents. Significant heterogeneity was apparent across studies. Firstly, seven studies identified participants based on frailty status whereas the remainder used alternative strategies to identify at-risk older adults such as need for social support, healthcare use, functional impairment, multimorbidity, low income status or high risk of NH admission. Secondly, the setting in which the intervention was carried out varied. Nine studies were predominantly carried out at home, while the remaining 12 studies were carried out in ‘OPD’ community clinics or general practice settings. While all studies included a member of the team with specialist geriatric expertise, there was considerable heterogeneity in the composition of the MDT and the number of healthcare professionals involved. Furthermore, there was significant ambiguity in the description of CGA, with limited information on how the care plan was integrated across settings. Little information including dosage of healthcare interactions with the patient, who delivered what parts of the intervention and the length of follow-up within the individualised care plan highlighted the ‘black box’ that is CGA. Lastly, due to the variety of outcome measures included, authors of this review recommend the need for further trials to examine the effect of community based CGA on functional status and HRQoL are required. Given that previous longitudinal data reported adverse socioeconomic circumstances are significantly associated with functional decline in older adults (37), further trials examining the effect CGA on functional status among this cohort is required. Outcomes at 30-and-180-day follow-up highlighted that older adults had a significantly higher HRQoL compared to baseline and high satisfaction with care. A fundamental component of the CGA process is the person-centred multifactorial assessment and development of an integrated and coordinated plan of care (38). A recent qualitative evidence synthesis and meta-ethnography of stakeholders’ experiences of CGA in the community and out-patient settings found that CGA in a home based or OPD setting allows for a holistic and integrated approach to care for community-dwelling older adults while increasing patient satisfaction and accessibility to care (39). It was also highlighted in this qualitative synthesis that clear communication between HCPs and patients supported a positive experience of CGA. However divergent experiences of meaningful involvement of older adults and their caregivers during the CGA process in the community/OPD setting exists (39). HCPs often assume that patients and caregivers are involved in the CGA process. However, older adults and their caregivers often experience a lack of understanding of what CGA is and an inadequate participation in care planning (39). In this prospective cohort study, the interdisciplinary team engaged in active goal setting and care planning with the patient and their caregiver from the outset along with regular communication between the case manager and the patient throughout the care journey. This entailed HCPs participating in open, two-way communication about the outcomes of their initial assessment, potential follow-up assessments, referrals and treatment options when required, thereby enhancing communication and the integrated care pathway. Implications for Research and Practice Frailty poses increased risk of adverse outcomes for older adults. Older adults prefer to live in their own home for as long as possible (40, 41). Our findings demonstrate that the presence of frailty as defined by the CFS, places community dwelling older adults at risk of adverse outcomes including NH admission. In this study, the CFS was included in the pre-defined inclusion criteria for referral to the CST-OP hub to stratify a cohort of older adults at risk of frailty. The identification of frailty is an indication for CGA (17), and the WHO states that detection of early markers of declines in intrinsic capacity is crucial to maintain, delay or reverse functional decline, prevent unnecessary emergencies and reduce healthcare utilisation among older adults (3). CST-OP care may have a role in reducing potentially avoidable hospital admission and hospital acquired disability. In terms of scale-up and implementation Integrated care is a complex intervention with significant implications for research and practice. The CST-OP model of care closely reflects the most common components of integrated care strategies outlined in a recent systematic review (12). By providing individualised, comprehensive and MDT care plans alongside effective case management techniques, the CST-OP model exemplifies the key elements categorized by the Rainbow Model of Integrated Care taxonomy, as described in the systematic review by Hayes and colleagues (12). These findings underscore the importance of further research to explore the scalability and broader implementation of such integrated care models. The alignment of with the WHO guideline on ‘Integrated care models: an overview’ (42) highlights the relevance of these components in enhancing clinical practice. Future research should focus on evaluating the effectiveness of ‘hub’ versus home based CGA for community-dwelling older adults. The heterogeneity of research exploring patient reported outcomes is evident across community-based CGA interventions (19, 21). Future use of standardised assessments to assess functional status and HRQoL for community-based CGA is warranted (19), (21). Only 6 of the 22 included trials in the Cochrane Review by Briggs and colleagues measured HRQoL (19). Moreover, measurement of patient satisfaction or experience of community-based CGA was not included (19). This cohort study addressed this research gap through incorporating a person-centred perspective through inclusion of a PROM, EQ-5D-5L (29). Given that implementation of PROMs, including HRQoL, that enable collaborative person-centred interventions enable more effective healthcare (23), HRQoL could be considered as a primary outcome for future RCTs that examine the impact of CGA. Furthermore, outcomes of this cohort study may be used to inform the design and delivery of future RCTs that examine the effectiveness of community-based CGA. Strengths and Limitations This is the first study that explored person-centered integrated CGA as a model of care for older adults who are referred to and screened by their GP to a CST-OP in an Irish setting. The use of patient reported outcome measures is one of the key strengths of this study and the impact of care was explored at both clinical and process level. The low rates of attrition at 30 and 180 days further enhances the reliability of our findings. This multi-site study increases the generalizability of findings. The involvement of PPI involvement informing the included outcomes is another strength of the study. This study supports the growing emphasis in research and policy on adopting a community-based approach to the delivery of care to older adults. As a result of the observational design of this study, the lack of randomization and of a control group is a limitation to this study. Although the analysis controlled for confounding factors, the true effect of exposures and outcomes cannot be out ruled. The majority of the population were white Irish which may affect the generalisability of findings to more diverse populations. The self-reporting of functional status may incur recall bias. The composition of the population mainly comprised of white Irish, which may affect the generalizability of findings outside of this cohort. Conclusion The model of integrated care delivered by the CST-OP may improve outcomes and mitigate against potentially avoidable ED presentations and hospitalisations among community-dwelling older adults. Presence of frailty was a significant predictor for adverse outcomes at 30 and 180 days, and a score of ³5 on the CFS frail were associated with increased risk of functional decline, increased rates of mortality, NH admission, hospitalisation or ED presentation at 30 and 180 days. Although the functional status decreased at long-term follow-up, older adults’ HRQoL significantly improved. Integrated care facilitating transfer of care away from the acute towards the primary care setting are key to the reform of healthcare delivery to older adults. Future research should consider the impact of a domiciliary based versus ‘hub’ based integrated model of care on community-dwelling older adults, using RCT methodology. Abbreviations CST OP, Community Specialist Teams for Older Persons; CGA, Comprehensive Geriatric Assessment; HRQoL, health-related quality of life; Emergency Department, ED; World Health Organization, WHO; multidisciplinary team, MDT; 21 randomised controlled trials, RCT; standardised mean difference, SMD; CI, confidence interval; FTE, full-time equivalent; CNS, clinical nurse specialist; ANP, advanced nurse practitioner; GP, General Practitioner; OTA, occupational therapist assistant; Clinical Frailty Scale, CFS; EuroQoL-5D-5L, EQ5D5L; Patient Assessment of Integrated Elderly Care, PAIEC; standard deviations, SD; interquartile ranges, IQR; PC, primary care; OR, odds ratio; NH, nursing home; hx, history. Declarations Ethics approval and consent to participate The study adheres to the Declaration of Helsinki and ethical approval for the study was granted by the Research Ethics Committee, University of Limerick Hospitals Group, Mid-West Region (Ref. 116/2021). Hard copies of signed participant consent forms were obtained for all participants. Consent for publication Written informed consent was obtained from all participants who were recruited during the duration of the study. Availability of data The datasets used and analysed within this study are available from the corresponding author on request. Competing interests The author(s) report no conflicts of interest in this work. Funding This research is funded through the Health Research Board (HRB) of Ireland (Health Research Board, Grattan House 67-72 Lower Mount Street, Dublin 2, D02 H638, Ireland) under the HRB Research Leader Award RL-2020- 010. Authors contributions CH conceptualised the study and was responsible for design of the work, analysis and interpretation of the data and writing the original draft preperation. RG was responsible for conceptualisation of the study, design of the work, analysis and interpretation of the data, supervision, and revised the manuscript from a critical perspective. AW reviewed data analysis. CH and CD were involved in the extraction of data. All authors including CH, RG, KR, CD, CF, BC, AL, MM, and AW contributed to the drafting and editing of the manuscript. All authors have read and approved the final draft of the manuscript. Acknowledgements The corresponding author is grateful to all participants and those important to them who were recruited to this study and engaged in follow-up CST-OP visit. She is also grateful to all co-authors who shared their knowledge, time and expertise during the study completion period. References World Health Organization. Integrated care for older people: Guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017. Department of Health. Health Service Capacity Review 2018 Executive Report. Dublin; 2018 23 Jan 2018. World Health Organization. Integrated care for older people (ICOPE): realigning primary health care to respond to population ageing. . 2018. British Geriatrics Society. Joining the dots: A blueprint for preventing and managing frailty in older people. United Kingdom; 2023. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The lancet. 2013;381(9868):752-62. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56(3):M146-M57. Kojima G, Iliffe S, Jivraj S, Walters K. Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis. J Epidemiol Community Health. 2016;70(7):716-21. Vermeiren S, Vella-Azzopardi R, Beckwee D, Habbig A-K, Scafoglieri A, Jansen B, et al. Frailty and the prediction of negative health outcomes: a meta-analysis. Journal of the American medical directors association. 2016;17(12):1163. e1-. e17. Kojima G. Frailty as a predictor of nursing home placement among community-dwelling older adults: a systematic review and meta-analysis. Journal of geriatric physical therapy. 2018;41(1):42-8. Shamliyan T, Talley KM, Ramakrishnan R, Kane RL. Association of frailty with survival: a systematic literature review. Ageing research reviews. 2013;12(2):719-36. TILDA. TILDA Wave 5 Key Findings: The Older Population of Ireland on the Eve of the COVID-19 Pandemic. Dublin; 2020. Christina Hayes MM, Christine Fitzgerald, Brian Condon, Anne Griffin, Margaret O’Connor, Liam Glynn, Katie Robinson, Rose Galvin. Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis. Health & Social Care in the Community. 2024. Liljas AE, Brattström F, Burström B, Schön P, Agerholm J. Impact of integrated care on patient-related outcomes among older people–a systematic review. International journal of integrated care. 2019;19(3). Condon B, Griffin A, Fitzgerald C, Shanahan E, Glynn L, O’Connor M, et al. Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis. BMC geriatrics. 2024;24(1):233. James Lind Alliance. Managing chronic conditions in Irish primary care https://www.jla.nihr.ac.uk/priority-setting-partnerships/managing-chronic-conditions-in-irish-primary-care/: James Lind Alliance 2024 [Available from: https://www.jla.nihr.ac.uk/priority-setting-partnerships/managing-chronic-conditions-in-irish-primary-care/. ICPOP Steering Group. Making a start in integrated care for older persons a practical guide to the local implementation of integrated care programmes for older persons. 2017. National Clinical Programme for Older People. Knowledge and Skills Framework for Healthcare Professionals Working with Older People. Dublin; 2023 08 Dec 2023. Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews. 2017(9). Briggs R, McDonough A, Ellis G, Bennett K, O'Neill D, Robinson D. Comprehensive Geriatric Assessment for community‐dwelling, high‐risk, frail, older people. Cochrane Database of Systematic Reviews. 2022(5). World Health Organization. World Report on Ageing and Health. Geneva; 2015. Report No.: ISBN: 9789241565042. Hayes C, Amanuel Yigezu, Sarah Dillon, Christine Fitzgerald, Molly Manning, Aoife Leahy, et al. Home-based comprehensive geriatric assessment for community-dwelling, at-risk, frail older adults: A systematic review and meta-analysis. Journal of the American Geriatrics Society. 2025. Hayes C, Manning M, Fitzgerald C, Condon B, Griffin A, O’Connor M, et al. Effectiveness of Community‐Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta‐Analysis. Health & Social Care in the Community. 2024;2024(1):6437930. Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. American College of Physicians; 1997. p. 1097-102. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bulletin of the World Health Organization. 2007;85:867-72. Executive HS. National Framework for the Integrated Prevention and Management of Chronic Disease in Ireland 2020-2025. Dublin, Ireland: Health Service Executive; 2020. Executive HS. Practice Guidance for Older Person Multi-Disciplinary Teams. 2021. Rockwood K, Theou O. Using the clinical frailty scale in allocating scarce health care resources. Canadian Geriatrics Journal. 2020;23(3):210. Fi M. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61-5. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of life research. 2011;20:1727-36. Sasseville M, Smith SM, Freyne L, McDowell R, Boland F, Fortin M, Wallace E. Predicting poorer health outcomes in older community-dwelling patients with multimorbidity: prospective cohort study assessing the accuracy of different multimorbidity definitions. BMJ open. 2019;9(1):e023919. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. European journal of internal medicine. 2016;31:3-10. Church S, Rogers E, Rockwood K, Theou O. A scoping review of the Clinical Frailty Scale. BMC geriatrics. 2020;20:1-18. Field A. Discovering statistics using IBM SPSS statistics: Sage publications limited; 2024. Metti AL, Best JR, Shaaban CE, Ganguli M, Rosano C. Longitudinal changes in physical function and physical activity in older adults. Age and ageing. 2018;47(4):558-64. Hajek A, Luck T, Brettschneider C, Posselt T, Lange C, Wiese B, et al. Factors affecting functional impairment among elderly Germans—results of a longitudinal study. The Journal of nutrition, health and aging. 2017;21(3):299-306. Saraiva MD, Rangel LF, Cunha JLL, Rotta TCA, Douradinho C, Khazaal EJB, et al. Prospective GERiatric Observational (ProGERO) study: cohort design and preliminary results. BMC geriatrics, unpublished data. 2020;20:1-12. Stringhini S, Carmeli C, Jokela M, Avendaño M, McCrory C, d’Errico A, et al. Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study. bmj. 2018;360. Rubenstein LZ, Stuck AE, Siu AL, Wieland D. Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. Journal of the American Geriatrics Society. 1991;39(S1):8S-16S. Hayes C, Fitzgerald C, O’Shaughnessy Í, Condon B, Leahy A, O’Connor M, et al. Exploring stakeholders’ experiences of comprehensive geriatric assessment in the community and out-patient settings: a qualitative evidence synthesis. BMC Primary Care. 2023;24(1):274. Gilleard C, Hyde M, Higgs P. The impact of age, place, aging in place, and attachment to place on the well-being of the over 50s in England. Research on aging. 2007;29(6):590-605. Gobbens RJ. Frailty in Community-Dwelling Older People. Healthcare (Basel). 2023;11(16). World Health Organization. Integrated care models: An overview Health Services Delivery Programme. Division of Health Systems and Public Health Copenhagen, Denmark; 2016. Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.docx AdditionalFile2.docx AdditionalFile3..docx AdditionalFile4..docx AdditionalFile5..docx Cite Share Download PDF Status: Published Journal Publication published 05 Jun, 2025 Read the published version in BMC Primary Care → Version 1 posted Editorial decision: Revision requested 20 Apr, 2025 Reviewers agreed at journal 18 Apr, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviews received at journal 13 Apr, 2025 Reviewers agreed at journal 13 Apr, 2025 Reviews received at journal 08 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers invited by journal 07 Apr, 2025 Submission checks completed at journal 03 Apr, 2025 First submitted to journal 02 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5890108","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":440138506,"identity":"4b6ee042-3030-4fb1-a603-b81b3b9e2c31","order_by":0,"name":"Christina Hayes","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACCQaGA2CSgQfMl2NgB4sQ0pKA0GLMwEyEFgaGBAa4lsQGZgLu4p/d+/Dgzx8WefwNvAc/81TUpW84zMB44AM+S+4cNzjMkyBRLHGAL1ma58zhXKAWhoMz8GgxkEhjOAz0S2LDAR4Dad62A2Ath3kIaDn4A6hl/gEe49+8/+rSDUBa/hDQcgDosMQNB3jMpHkbmBPAWvB5X+IG0GE8aRKJGw/zmFnOOXbYcOZhxoaDPXi08M9IY/74w6Yucd7xHuMbb2rq5PmONx/+8AOfNXAAjA4miK8ZG4jSAFFLnOGjYBSMglEw0gAARp5OAJroNoIAAAAASUVORK5CYII=","orcid":"","institution":"School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick","correspondingAuthor":true,"prefix":"","firstName":"Christina","middleName":"","lastName":"Hayes","suffix":""},{"id":440138507,"identity":"0841bc2e-70c4-403c-b6ed-b21ca510ab87","order_by":1,"name":"Aoife Whiston","email":"","orcid":"","institution":"Department of Psychology, University of Limerick, Castletroy, Limerick","correspondingAuthor":false,"prefix":"","firstName":"Aoife","middleName":"","lastName":"Whiston","suffix":""},{"id":440138508,"identity":"d32e9317-e9ff-47e0-9b5f-7f4036a0f21d","order_by":2,"name":"Christine Fitzgerald","email":"","orcid":"","institution":"School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick","correspondingAuthor":false,"prefix":"","firstName":"Christine","middleName":"","lastName":"Fitzgerald","suffix":""},{"id":440138509,"identity":"1cace350-02fa-4781-8454-89706aa6e5bd","order_by":3,"name":"Collette Devlin","email":"","orcid":"","institution":"School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick","correspondingAuthor":false,"prefix":"","firstName":"Collette","middleName":"","lastName":"Devlin","suffix":""},{"id":440138510,"identity":"3d6a0250-7165-40ec-81eb-9829d27dd7d0","order_by":4,"name":"Brian Condon","email":"","orcid":"","institution":"School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick","correspondingAuthor":false,"prefix":"","firstName":"Brian","middleName":"","lastName":"Condon","suffix":""},{"id":440138511,"identity":"30664225-11e3-4a86-ab11-bb58ced355c3","order_by":5,"name":"Molly Manning","email":"","orcid":"","institution":"School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick","correspondingAuthor":false,"prefix":"","firstName":"Molly","middleName":"","lastName":"Manning","suffix":""},{"id":440138512,"identity":"fa1f9c18-0c1f-4b27-a7c8-3e1665a7b83f","order_by":6,"name":"Aoife Leahy","email":"","orcid":"","institution":"St. Camillus' Hospital for the Elderly","correspondingAuthor":false,"prefix":"","firstName":"Aoife","middleName":"","lastName":"Leahy","suffix":""},{"id":440138515,"identity":"9d929405-2f72-4f00-9572-d854219cf29e","order_by":7,"name":"Katie Robinson","email":"","orcid":"","institution":"School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick","correspondingAuthor":false,"prefix":"","firstName":"Katie","middleName":"","lastName":"Robinson","suffix":""},{"id":440138517,"identity":"a4ab086f-d8f0-43f1-b738-8209b1ac743d","order_by":8,"name":"Rose Galvin","email":"","orcid":"","institution":"School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Castletroy, Limerick","correspondingAuthor":false,"prefix":"","firstName":"Rose","middleName":"","lastName":"Galvin","suffix":""}],"badges":[],"createdAt":"2025-01-23 17:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5890108/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5890108/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12875-025-02895-x","type":"published","date":"2025-06-05T15:57:40+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84243201,"identity":"ff3f441c-a6f5-4624-a6cd-fe7d7dcfb29b","added_by":"auto","created_at":"2025-06-09 16:12:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1032583,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5890108/v1/f08f9f82-6c0e-4684-8cce-2e2104008ce4.pdf"},{"id":80226334,"identity":"ae922904-fe24-46a1-8437-b14d920423b3","added_by":"auto","created_at":"2025-04-09 11:43:29","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":24593,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5890108/v1/120ee1a16de7df82a74e8547.docx"},{"id":80226337,"identity":"df64cbcf-62c1-4045-9ee8-844d3996f4e2","added_by":"auto","created_at":"2025-04-09 11:43:29","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17483,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5890108/v1/9c0c5a84ab1f42b87001bfde.docx"},{"id":80226336,"identity":"3658cb2d-b3ed-4128-af73-80edaa27f0d0","added_by":"auto","created_at":"2025-04-09 11:43:29","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20006,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile3..docx","url":"https://assets-eu.researchsquare.com/files/rs-5890108/v1/9fb033fb624e56eebdb241fa.docx"},{"id":80226338,"identity":"ff1b3395-a827-4a6a-b153-2ea6dbb7b866","added_by":"auto","created_at":"2025-04-09 11:43:29","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":17126,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile4..docx","url":"https://assets-eu.researchsquare.com/files/rs-5890108/v1/34d0827310ddc9247475bc64.docx"},{"id":80226335,"identity":"fb4ac05f-3ffb-4e92-83e9-0e47f7cc2786","added_by":"auto","created_at":"2025-04-09 11:43:29","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":17355,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile5..docx","url":"https://assets-eu.researchsquare.com/files/rs-5890108/v1/f31b74d5416a2a164d853ecc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Community Specialist Teams for Older Persons (CST-OP) at risk of, or living with frailty in Ireland: a prospective cohort study of a new model of integrated care for community dwelling older adults","fulltext":[{"header":"Background","content":"\u003cp\u003eThe proportion of older adults is increasing rapidly worldwide (1). There is a particularly fast growth in the oldest old, with number of adults aged over 85 years expected to increase by 95.5% by 2031 (2). As people age, they experience a decline in their intrinsic capacity, ultimately leading to more chronic and complex health issues (3), increased care dependency and increased susceptibility to frailty (4, 5). Frailty, a consequence of age related decline in multiple physiological systems commonly resulting in heightened vulnerability to sudden health changes, placing older adults at increased risk of poor health outcomes (5, 6). Community-dwelling older adults living with frailty are additionally at increased risk of reduced health-related quality of life (HRQoL) (7), functional decline (8), increased rate of hospitalisation (8), nursing home (NH) admission (9) and mortality (10) compared to their non-frail community-dwelling older adults . With a quarter of adults aged over 75 years, and over half of adults aged 85 years living with frailty (4, 5, 11), intervening at an early stage of developing frailty is a priority across health systems internationally (1). However, realigning health and social care systems to deliver care to older adults is challenging in the context of an ageing population globally(3). As such, integrated care strategies targeting enhanced health outcomes and HRQoL for older adults are an increasing focus of health policy and service delivery (3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIntegrated care is a person centred model of care whereby services that span across the different levels and sites of care are co-ordinated and integrated according to an individual\u0026rsquo;s needs (3). Varied models of integrated care exist, underpinning the complexity of its implementation (12). The World Health Organization (WHO) guidelines for integrated care for older people do however, recommend a holistic assessment, a common goal and a care plan for older adults with particular focus on early intervention within the community setting (1, 3). Integrated care strategies for older adults has demonstrated reduced rates of hospitalisations, length of hospital stay and improved patient satisfaction (13). Two of the challenges of integrating healthcare, according to older adults receiving community services, are fragmented communication strategies by healthcare professionals and a discontinuity of care while transitioning across care settings (14). This is further highlighted in the output of a recent Priority Setting Partnership with the James Lind Alliance, where improving the exchange of information between specialist/acute and primary care services within the Irish setting was reported as the top research priority in managing chronic conditions in primary care (15). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn order to facilitate integrated healthcare reform in Ireland, the national Integrated Care Programme for Older People has implemented a number of initiatives to facilitate a shift away from acute episodic care to longitudinal coordinated and integrated care for older adults that allows them to access care closer to home (16). One such approach is the establishment of community specialist teams for older people (CST-OP) whereby experienced multidisciplinary team (MDT) individuals from medical, nursing, pharmacy and health and social care professions offer prompt comprehensive geriatric assessment (CGA) in the community to older adults (16, 17). CGA is defined as a multidimensional approach to assessment of an older adults medical, psychological, functional ability and social circumstances in order to develop a personalised coordinated and integrated plan for treatment and follow-up (18). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe research evidence base reports mixed results to support the effectiveness of CGA in the community setting (19). A recent Cochrane review and meta-analysis of 21 randomised controlled trials (RCT) examining the effectiveness of community-based CGA (including within the participant\u0026rsquo;s home, general practice, or community-based clinic) for community-dwelling frail older adults found no improvement in functional status (standardised mean difference (SMD): \u0026nbsp;-0.09; 95% CI: \u0026minus;0.24 to 0.05) and little change in the health related quality of life (HRQoL) (SMD: 0.10; 95% CI: 0.00\u0026ndash;0.21) among this cohort (19). However, there was heterogeneity across studies with regards to the description of \u0026lsquo;CGA\u0026rsquo; interventions delivered. Given the uncertainty of community-based CGA and the variations in its operation, this review called for future research to examine its effectiveness (19). Furthermore, the WHO called for future longitudinal research to investigate profiles of older adult\u0026rsquo;s functional abilities and healthcare needs in order to realise the goal of Healthy Ageing (20). The heterogeneity of person-centred outcomes and lack of a core outcome set incorporating patient-reported outcome measures (PROMs) across community-based CGA research (19, 21, 22) has led to a lack of robust evidence to support its effectiveness. Implementation of PROMs that enable collaborative person-centred interventions ensure more effective healthcare (23). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis prospective cohort study is the first study nationally to explore the process, clinical and patient-reported outcomes of older adults over a 6-months period, who are referred to one of the three CST-OP hubs in the Mid-West of Ireland by their GP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis prospective cohort study was conducted in line with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines (Additional File 1) (24). Data collection and follow-up took place during the period of February 2022 to December 2023 (inclusive). The study protocol was registered on Clinicaltrials.gov (NCT05527223). Registered January 09, 2022. https://clinicaltrials.gov.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was granted by the Research Ethics Committee, University of Limerick Hospitals Group, Mid-West Region (Ref. 116/2021).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSetting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis multi-site study took place at three CST-OP hubs across the Mid-West region. Each of these hubs serve an approximate population of 150,000 people and has a population of approximately 34,000 people living with a chronic disease (25).\u003c/p\u003e\n\u003cp\u003eThe CST-OP multidisciplinary team comprised specialist geriatrician, nursing and allied health disciplines. This team was operational from 8:00-17:00 Monday-Friday. A typical detailed description of the referral, assessment and closure process at the CST-OP is available in appendix 5 of the \u0026ldquo;Practice Guidance for Older-Person Multidisciplinary Teams\u0026rdquo; (26). Referrals were sent by GPs directly to the CST-OP. All referrals received by the CST-OP were triaged by a member of the MDT and geriatrician. All participants who were assessed in-person by their GP and met inclusion criteria were considered eligible.\u003c/p\u003e\n\u003cp\u003eA detailed description of the MDT composition across the three sites is outlined in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Multidisciplinary team composition at each CST-OP\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCST-OP Site 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCST-OP Site 2\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCST-OP Site 3\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eData collection period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eFebruary 2022- January 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eJune 2022- April 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMay 2022- June 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGeriatrician (FTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.5 FTE June-Dec 2022.\u003c/p\u003e\n \u003cp\u003e1 FTE from June 2023 onwards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.5 FTE May - Dec 2022\u003c/p\u003e\n \u003cp\u003eVaried locum medical agency cover December 2022 onwards\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eCNS (FTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eANP (FTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eSenior Physiotherapist (FTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e(Maternity leave from July 22- March 23) agency cover for small period of this time)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003ePhysiotherapy assistant (FTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1 August 2023 onwards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eSenior Occupational Therapist (FTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eSenior Speech and Language Therapist (FTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1 May 2023 onwards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eSenior Dietician (FTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1 (Was on leave for part of study)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003cp\u003eRegistrar\u003c/p\u003e\n \u003cp\u003eGP\u003c/p\u003e\n \u003cp\u003eCase Manager\u003c/p\u003e\n \u003cp\u003eOTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: FTE, full-time equivalent; CNS, clinical nurse specialist; ANP, advanced nurse practitioner; GP, General Practitioner; OTA, occupational therapist assistant\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePopulation of Interest and recruitment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll older adults aged \u0026ge;75 years who were referred to the CST-OP hub by their GP during recruitment periods were considered eligible for participation in the study, if they met the following inclusion/exclusion criteria:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eInclusion criteria\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ePatients aged \u0026ge;75 years who were referred to the CST-OP hub by their GP, scored between 4 and 6 on the Rockwood Clinical Frailty Scale (CFS) (27)(pre-frail, mildly frail or moderately frail), resided within the catchment area of the relevant CST-OP hub, had been assessed in-person by the referrer, did not have community MDT input within the last three months.\u003c/p\u003e\n\u003cp\u003eAnd any one of the following criteria:\u003c/p\u003e\n\u003cp\u003eFall within the last month unrelated to acute cardiac or neurological cause and no previous falls assessment, increased dependency or increased carer burden in the last month, a deterioration in swallow in the previous month including symptoms of recurrent chest infections, weight loss, coughing when eating/drinking, self-modifying diet secondary to difficulties or experienced an adverse drug reaction within the last month excluding allergic reaction.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eExclusion criteria\u003c/em\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ePatients were excluded if they presented with an acute neurological or cardiovascular event, were more appropriate to an alternative care pathway or service e.g. primary care or geriatric medicine clinic, presented with injuries, unless the injury had already been appropriately managed, were experiencing an acute medical illness requiring treatment in an acute hospital setting, if care was being provided by other health care professionals at the time of referral and it was apparent that they are working to meet goals aligned with that current service, they required investigation or treatment not available in the relevant CST-OP hub (unless these investigations are already being arranged elsewhere), they have had MDT input in the previous three months, had confirmed or suspected Covid-19 infection or other exclusions at the discretion of the CST-OP based on clinical expertise and available resource.\u003c/p\u003e\n\u003cp\u003eConsecutive participants were identified by a member of the MDT. It was assumed that participants had the ability to consent or decline participation unless the research nurse determined they lacked capacity. The research nurse explained the study to the potential participant. If an older adult was able to understand, retain, and articulate the details of the study to the research nurse, and could assess the information to make an informed decision, their capacity was considered intact. If a participant could not demonstrate these abilities, they were regarded as lacking the capacity to consent, and proxy consent was obtained from the next of kin, with the patient\u0026apos;s assent. The next of kin was given time to review the study and ask questions on the patient\u0026rsquo;s behalf. Hard copies of signed participant consent forms were stored in a locked filing cabinet in a locked office on-site.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExposure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll participants underwent a CGA which was initiated at index visit to the CST-OP hub. A medical assessment including medication review, blood pressure and physical assessment was led by the geriatrician. A falls assessment, assessment of mobility and stairs, transfers, personal care, activities of daily living (ADLs), social supports and environmental, cognition, and nutritional assessments were conducted by a member of the MDT. Personalised goals were discussed with patients to inform the care plan. The geriatrician oversaw the medical management of all participants. The MDT then created a clinical problem list based on the patient\u0026rsquo;s presentation and created a recommended plan of care which was discussed at a weekly MDT meeting. Diagnostic procedures (e.g. DXA scan, Tilt Table testing, ECG, 24-hour ambulatory blood pressure monitoring) were carried out at the hub or relevant hospital where required. Patients received out-patient medical, allied health professional or nursing input over a period of up to six weeks or dependent on the patient\u0026rsquo;s ongoing needs. Patients were also referred to other community-based services including public health nurse, home healthcare or specialist out-patient / in-patient care etc. where appropriate. Referrals to voluntary social support services for older adults were also initiated where relevant. Patients were discharged when their duration of care concluded, as determined by the geriatrician and were discharged back to their GP. Consistent with the components of CGA reported by Ellis and colleagues (18), the fundamental components of CGA adopted are outlined in Additional File 2.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBaseline data collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBaseline consent and assessments were completed by members of the CST-OP. The baseline assessment comprised of demographic variables and validated health measures. Demographic information included participant\u0026rsquo;s age, sex, ethnicity, marital status, residential status, socioeconomic status, education level and living circumstances were recorded. The health assessment included: presenting problem, smoking status, alcohol consumption, mobility status, 12-month self-report falls history, co-morbidities (Charlson Co-morbidity index), global measure of function (Barthel Index), frailty status (CFS) and quality of life (EuroQoL-5D-5L).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFollow-up data collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were followed-up via telephone call at 30-days and 6-months post index visit by an independent member of the research team (CH or CD) who were not involved in the patients routine care. Data on objective and health measures including: ED presentation, Acute Medical Assessment Unit attendance, hospitalisation, NH admission, incidence of falls, functional status (Barthel Index), mortality, use of geriatric services, use of other primary care services during this timeframe, participant satisfaction with care (Patient Assessment of Integrated Elderly Care) and quality of life (EQ5D5L) were recorded.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePrimary outcome- functional status at baseline, 30 days and 6 months, as measured by the Barthel Index (28).\u003c/p\u003e\n\u003cp\u003ePrimary healthcare use (within and outside of CST-OP healthcare utilisation). This included the number of services that participants were in receipt of following index visit at the CST-OP hub including; GP visits, Public Health Nurse visits, Health and Social Care Professional use, formal homecare support at 30-days and 180-days.\u003c/p\u003e\n\u003cp\u003eSecondary healthcare utilisation. This included the number of secondary healthcare services that participants were in receipt of including; Outpatient services, ED presentation and unplanned hospital admission at 30-days and 180-days.\u003c/p\u003e\n\u003cp\u003ePatient satisfaction. Participants evaluated the quality of integrated care across a number of domains using the Patient Assessment of Integrated Elderly Care (PAIEC) Questionnaire at 30-days.\u003c/p\u003e\n\u003cp\u003eQuality of life: Participants rated their HRQoL using the EuroQoL-5D-5L (29) at 30-days and 6-months.\u003c/p\u003e\n\u003cp\u003eMortality: The number of participants who died following their index visit at the CST-OP hub 30-days and 180-days.\u003c/p\u003e\n\u003cp\u003eNursing home admission: Number of participants who were admitted to a nursing home or residential care facility following their index visit to the CST-OP hub 30-days and 180-days.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample size\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOur study was not hypothesis driven; therefore, formal power calculations were not applicable. All prospective older adults that met inclusion criteria were invited to participate during the study recruitment period (January 2022-2023 inclusive).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were used to profile the baseline characteristics of the cohort. Categorical data (e.g. biological sex) were analysed using frequencies and percentages. Continuous data (e.g. age) were analysed using means and standard deviations (SD) or median and interquartile ranges (IQR) where data demonstrated evidence of skewness (e.g. BI). One-way within-subjects ANOVAs were conducted to examine differences in functional status (Barthel Index) and HRQoL (EQ5D5L) across timepoints \u0026ndash; index, 30 days, and 180 days. Separate multivariate logistic regressions were conducted to explore predictors of adverse outcomes at 30 and 180-days. Multimorbidity (30) and frailty (31, 32) are predictors for adverse outcomes for older adults. Based on previous research, frailty, age, biological sex, falls at baseline, presence of co-morbidities and number of interventions received from the CST-OP were the predictors explored. For all logistic regression models, odds ratios with 95% odds ratio scale CIs were reported. Relative Risk (RR) and corresponding 95% CIs were calculated to determine the risk of adverse outcomes at 30 days and 180 days at a cut-off score of \u0026sup3;5 on the CFS. A 5% level of significance was used for all statistical tests. All statistical analyses were undertaken using SPSS Version 24.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 303 participants were recruited from February 2022- June 2023. Demographic and clinical characteristics of the overall sample are presented in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mean age of participants was 83.23 years (SD = 5.77) with females representing 67.7% of the total population. The majority of the population were white Irish (99.3%) and almost half were widowed (45.9%) and lived alone (47.2%). The prevalence of frailty, categorised as \u0026sup3;5 on the CFS, was 55.4% (n=168). The most common presenting problem to the CST-OP was due to falls (43.9%), with over half of the cohort experiencing a fall in the 12 months prior to their index visit (58.7%). The median Barthel score was 18 (IQR = 3) and the median CFS score was 5 (IQR = 1) therefore, defined as living with mild frailty.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Baseline characteristics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N= 303)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eAge, mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e83.23 (5.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eFemale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e205 (67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eEthnicity, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eWhite Irish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e301 (99.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eOther white background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eBlack Irish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eMarital status, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e123 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eIn a relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e24 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e139 (45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSeparated/divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e16 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eResidential status, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eLives alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e143 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eLives with family (spouse)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e44 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e116 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003ePresenting problem, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eFalls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e133 (43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eReduced Mobility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e46 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eIncreased Frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e42 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eCognitive Impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e22 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eDizziness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e14 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eIncreased dependency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e8 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eUnsteady gait\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e7 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e5 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eParkinsons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e4 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSyncope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eVertigo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eCOPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eFunctional decline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eChronic Pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eHeadaches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eBreathlessness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003ePost CVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eConfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eIncreased carers burden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSleep deprivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eAtrial Fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSocioeconomic status, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eAffluent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e6 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eMarginally above average\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e125 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eMarginally below average\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e128 (42.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eDisadvantaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e33 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eVery Disadvantaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e11 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eLiving circumstances, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSingle storey house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e29 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003e2 storey house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e165 (54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003e3 storey house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e5 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eFlat ground floor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e6 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eFlat above ground\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eBungalow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e92 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSheltered housing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSmoking, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e201 (66.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e22 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003ePrevious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e78 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eOccasional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eAlcohol, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e163 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e58 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003ePrevious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e30 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eOccasional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e51 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eHistory of falls in past 12-months, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e178 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eBarthel Index, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e18 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eCFS median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eEQ-5D-5L Index Value, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e0.68 (0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eMobility, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eSelf-care, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e1 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eUsual activities, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003ePain, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eAnxiety, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e2 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eEQ-5D-5L visual analog scale,\u0026nbsp;median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e70 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 330px;\"\u003e\n \u003cp\u003eCharlson comorbidity index,\u0026nbsp;median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e3 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Median and IQR are presented where data are not normally distributed\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes at 30 days\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIncidence of functional decline was reported at 26.4% (n=80) across the overall number of participants as measured by the BI. \u0026nbsp;At 30 days the mortality rate was 1% (n=3). Data were unavailable for seven participants on the PAIEC outcome (n=1 declined and n=6 not reported). The average PAIEC score was 82.80 (SD = 1.099). A detailed analysis of the PAIEC is available in Additional File 3.\u003c/p\u003e\n\u003cp\u003eIn terms of process outcomes (see Table 3), almost seven percent of the cohort experienced an unplanned ED presentation (6.9%) (n=21), 6.6% experienced an unplanned hospital admission (n=20) and 35.6% had an OPD appointment in the acute setting (n=108). Sixteen percent (n=49) of participants used acute care services. Twelve participants were admitted to a NH (4%). At 30-day follow-up, 13.2% of participants were discharged from the CST-OP (n=40).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Overall 3-sites 30- and 180- day descriptives\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0 - 30\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edays\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026ndash; 180 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eDied, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e9 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eED attendance, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e21 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e72 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eAMU attendance, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e8 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eMAU attendance, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e2 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e27 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eLIU attendance, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e10 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eEMS Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e1 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eHospital admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e20 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e60 (19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eCombined acute care use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e49 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e177 (58.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eNH admission, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e12 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e31 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eFalls incidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e42 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e75 (24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eFunctional decline (binary), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e80 (26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e102 (33.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eDischarge from CST-OP, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e40 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e261 (86.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003ePrimary care service use, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e226 (74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e278 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003ePAIEC, mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e82.80 (1.099)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e ED, emergency department; AMU, acute medical unit; MAU, medical assessment unit; LIU, local injury unit; EMS, emergency medical services (ambulance services); NH, nursing home; CST-OP, community specialist team for older people; PAIEC, patient assessment of integrated elderly care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeparate logistic regression models were estimated to explore if baseline characteristics predicted adverse outcomes at 30-day (Table 4). Our pooled data demonstrated that the presence of frailty (measured as\u0026nbsp;\u0026sup3;5 on the CFS) is a significant predictor of functional decline at 30 days OR 1.475 (1.111,1.95), NH admission 2.088 (1.060,4.11), hospitalisation OR 2.213 (1.289, 3.800), ED presentation OR 2.160 (1.309, 3.563), primary care use OR 1.338 (1.004, 1.783) and mortality OR 5.565 (1.328, 23.327) at 30 days. Female biological sex was a significant predictor of higher primary care service use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Total Sample Logistic Regression Models\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional decline (binary)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNH admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalisation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eED admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePC services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCFS, OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;1.475 (1.111,1.959)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.088 (1.060,4.11)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.213 (1.289, 3.800)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.160 (1.309, 3.563)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.338 (1.004, 1.783)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e5.565 (1.328, 23.327)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.001 (0.955,1.048)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.053 (0.944, 1.174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.023 (0.941, 1.112)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.965 (0.891, 1.046)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.038 (0.989, 1.089)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1.016 (0.829, 1.246)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiological sex, OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.013 (0.574, 1.790)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.367 (0.348, 5.371)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.360 (0.133, 0.973)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.470 (0.184, 1.200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.699 (0.380, 1.286)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.240 (0.018, 3.295)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalls at baseline (12-month hx), OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.029 (0.596, 1.776)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.425 (0.396, 5.132)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.722 (0.267, 1.950)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.119 (0.428, 2.927)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.214 (0.695, 2.123)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;**not applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharlson, OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.006 (0.985, 1.027)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.956 (0.714, 1.280)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.915 (0.710, 1.180)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.996 (0.947, 1.048)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.138 (0.983, 1.318)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.769 (0.369, 1.601)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e180 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctional decline (binary)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNH admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalisation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eED admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePC services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCFS, OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.672 (1.254, 2.229)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.499 (0.976, 2.303)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.499 (1.088, 2.067)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.577 (1.163, 2.140)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1.429 (0.874,2.339)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e2.618 (1.156, 5.927)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.037 (.991, 1.085)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.115 (1.037, 1.198)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.006 (.955, 1.059)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.004 (0.957, 1.054)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e.891 (.815,0.974)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1.089 (0.957, 1.240)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiological sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.772 (0.449, 1.329)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.092 (.474, 2.514)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e.97 (.523, 1.833)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.713 (0.398, 1.278)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.154 (0.034, 0.697)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.748 (0.166, 3.368)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFalls at baseline (12-month hx), OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.166 (0.688, 1.977)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.517 (0.674, 3.412)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.220 (0.665, 2.237)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e.700 (.399, 1.228)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.515 (.192, 1.379)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.495 (0.111, 2.211)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharlson, OR [CIs]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.993 (0.877, 1.125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.115 (.939, 1.324)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.039 (.905, 1.192)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.951 (0.828, 1.091)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.988 (0.789, 1.236)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.961 (.677, 1.364)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: *p\u0026lt;0.05. **As there were 0 count of falls in the group that did not die, there was not enough power to include falls at baseline (12-month history) in this analysis (33).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: CFS, clinical frailty scale; ED, emergency department; NH, nursing home; CST-OP, community specialist team older people; PC, primary care; OR, odds ratio; CI, confidence interval; hx, history.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes at 180 days\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a significant difference in functional status, F (2, 556) = 12.572, p \u0026lt; .001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e = 0.43. Self-reported functional status was maintained at 30-days post index visit 17.64 (2.68) mean (SD), but there was a significant decline at 180-days 17.1 (3.5) mean (SD). The mortality rate was 3% (n=9) at 180 days. The incidence of functional decline was 33.7% (n=102). In terms of process outcomes (see Table 3), 23.8% (n=71) of participants experienced an unscheduled ED presentation, 19.8% (n=60) experienced an unplanned hospital admission, 10.2% (n=31) were admitted to a NH and 53.8% (n=163) had an OPD appointment in the acute setting. Fifty-eight percent (n=177) of participants used acute care services. At 180-day follow-up 86.1% (n=161) were discharged from the CST-OP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeparate logistic regression models were estimated to explore if baseline characteristics predicted adverse outcomes at 180-days (Table 4). Our pooled data demonstrated that the presence of frailty (as measured as \u0026sup3;5 on the CFS) is a significant predictor of functional decline OR 1.672 (1.254, 2.229), NH admission OR 1.499 (0.976, 2.303), hospitalisation OR 1.499 (1.088, 2.067), ED presentation OR 1.577 (1.163, 2.140), and mortality OR 2.618 (1.156, 5.927) at 180-days. Female biological sex and increasing age were significant predictors of higher primary care service use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere was a significant improvement in HRQoL index values between index visit and 30-days 0.7 (0.30) mean (SD) and between index and 180-days 0.68 (SD 0.32) mean (SD), F (2, 542) = 13.839, p \u0026lt; .001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e = 0.49. No significant differences were observed between index and 30-days but there was a significant decline in HRQoL as per the VAS between 30 and 180 days (p=0.04, 95% confidence interval (CI) 0.083-5.672).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMultidisciplinary care received by participants\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe number of interventions provided by the CST-OP allied health professionals is outlined in Additional File 4. Most participants received physiotherapy input (61.1% at 30-days and 64.7% at 180-days). The second most common allied health professional input was SLT at 30-days followed by OT and dietetic input respectively (Additional File 4). Almost 16% of participants received OT input at 180days, 15.5% received speech and language input and 7.9% were seen by a dietician at 180-days (Additional File 4). \u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCommunity services and integration of healthcare\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants also received care for PCCC services.\u003c/p\u003e\n\u003cp\u003eAlmost three quarters of participants used primary care services (n=226) over the 30-day period while 91.7% (n=278) used PCCC services between 30 and 180 days. A detailed breakdown of PCCC use is available in Additional File 5. The number of GP attendances increased from 31% attending the GP between index and 30 days while 69.3% attended the GP between 30-days and 180days. An increase of home help services was also observed (29.7% at 30-days vs 46.2% at 180 days). A low rate of onward referral to routine community allied health professional services was noted across timepoints with 8.3% being referred for PT, 7.9% for OT, 1% for SLT and dietetics at 30-days.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective cohort study explored the clinical and process outcomes of community-dwelling older adults who were screened by and referred to one of three CST-OP hubs in the Mid-West of Ireland by their GP and received CGA, over a period of six months after their initial hub attendance. The presence of frailty (as measured as \u0026sup3;5 on the CFS) was a significant predictor of functional decline, NH admission, hospitalisation, ED presentation, primary care use and mortality at 30 days and of functional decline, hospitalisation, ED presentation and mortality at 180 days. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur findings demonstrate that despite the pre-frail/frail presentation of older adults to the CST-OP hub, functional status was maintained at 30 days. There was, however, a significant reduction in functional status at 180 days. Our findings parallel those of \u0026nbsp;two prospective cohort studies that reported a significant decrease in physical functioning among German and American community-dwelling older adults \u0026ge;75 years over time (34, 35). Similarly, our findings are further comparable to the Brazilian PerGERO prospective cohort study of community-dwelling older adults who underwent OPD CGA (36). Seventy-seven percent of participants in this study were living with frailty or pre-frailty and had mean age of 82 years (SD=8). Based on data provided by the main author, over a 12-month follow-up period 20.28% experienced functional decline, 9.88% died, 24.10% were hospitalized, 55.61% attended the ED and 2% were admitted to a NH (36). However, it must be noted that some clinical and methodological differences between this study and our cohort study existed. Namely, this study included some older adults who were not living with frailty, the team composition of this study only included nurses and geriatricians, and it lacked detail on any follow-up intervention procedures post assessment (36). A decline in functional status can be attributed to several factors. At a biological level, ageing is characterised as damage at a molecular and cellular level that ultimately leads to a progressive decline in bodily functions (20).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFindings from our prospective cohort study also align with those from a recent Cochrane review of 21 RCTs examining the effectiveness of community-based CGA that found little to no improvement on functional status (SMD \u0026minus;0.09, 95% CI \u0026minus;0.24-0.05) and other clinical and process outcomes including mortality (RR 0.88, 95% CI 0.76-1.02), ED presentations (RR 0.65, 95% CI 0.26-1.59), NH admission (RR 0.93, 95% CI 0.76- 1.14) and little change in \u0026nbsp;HRQoL (SMD 0.10, 95% CI 0.00-0.21 among community-dwelling older adults (19). This review provided data on 7893 older adults across 10 countries and four continents. Significant heterogeneity was apparent across studies. Firstly, seven studies identified participants based on frailty status whereas the remainder used alternative strategies to identify at-risk older adults such as need for social support, healthcare use, functional impairment, multimorbidity, low income status or high risk of NH admission. Secondly, the setting in which the intervention was carried out varied. Nine studies were predominantly carried out at home, while the remaining 12 studies were carried out in \u0026lsquo;OPD\u0026rsquo; community clinics or general practice settings. While all studies included a member of the team with specialist geriatric expertise, there was considerable heterogeneity in the composition of the MDT and the number of healthcare professionals involved. Furthermore, there was significant ambiguity in the description of CGA, with limited information on how the care plan was integrated across settings. Little information including dosage of healthcare interactions with the patient, who delivered what parts of the intervention and the length of follow-up within the individualised care plan highlighted the \u0026lsquo;black box\u0026rsquo; that is CGA. Lastly, due to the variety of outcome measures included, authors of this review recommend the need for further trials to examine the effect of community based CGA on functional status and HRQoL are required. Given that previous longitudinal data reported adverse socioeconomic circumstances are significantly associated with functional decline in older adults (37), further trials examining the effect CGA on functional status among this cohort is required.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOutcomes at 30-and-180-day follow-up highlighted that older adults had a significantly higher HRQoL compared to baseline and high satisfaction with care. A fundamental component of the CGA process is the person-centred multifactorial assessment and development of an integrated and coordinated plan of care (38). A recent qualitative evidence synthesis and meta-ethnography of stakeholders\u0026rsquo; experiences of CGA in the community and out-patient settings found that CGA in a home based or OPD setting allows for a holistic and integrated approach to care for community-dwelling older adults while increasing patient satisfaction and accessibility to care (39). It was also highlighted in this qualitative synthesis that clear communication between HCPs and patients supported a positive experience of CGA. However divergent experiences of meaningful involvement of older adults and their caregivers during the CGA process in the community/OPD setting exists (39). HCPs often assume that patients and caregivers are involved in the CGA process. However, older adults and their caregivers often experience a lack of understanding of what CGA is and an inadequate participation in care planning (39). In this prospective cohort study, the interdisciplinary team engaged in active goal setting and care planning with the patient and their caregiver from the outset along with regular communication between the case manager and the patient throughout the care journey. This entailed HCPs participating in open, two-way communication about the outcomes of their initial assessment, potential follow-up assessments, referrals and treatment options when required, thereby enhancing communication and the integrated care pathway. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eImplications for Research and Practice\u003c/h2\u003e\n\u003cp\u003eFrailty poses increased risk of adverse outcomes for older adults. Older adults prefer to live in their own home for as long as possible (40, 41). Our findings demonstrate that the presence of frailty as defined by the CFS, places community dwelling older adults at risk of adverse outcomes including NH admission. In this study, the CFS was included in the pre-defined inclusion criteria for referral to the\u0026nbsp;CST-OP\u0026nbsp;hub to stratify a cohort of older adults at risk of frailty. The identification of frailty is an indication for CGA\u0026nbsp;(17), and the WHO states that detection of early markers of declines in intrinsic capacity is crucial to maintain, delay or reverse functional decline, prevent unnecessary emergencies and reduce healthcare utilisation among older adults\u0026nbsp;(3).\u0026nbsp;CST-OP\u0026nbsp;care may have a role in reducing potentially avoidable hospital admission and hospital acquired disability.\u003c/p\u003e\n\u003cp\u003eIn terms of scale-up and implementation\u003c/p\u003e\n\u003cp\u003eIntegrated care is a complex intervention with significant implications for research and practice. The CST-OP model of care closely reflects the most common components of integrated care strategies outlined in a recent systematic review (12). By providing individualised, comprehensive and MDT care plans alongside effective case management techniques, the CST-OP model exemplifies the key elements categorized by the Rainbow Model of Integrated Care taxonomy, as described in the systematic review by Hayes and colleagues (12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese findings underscore the importance of further research to explore the scalability and broader implementation of such integrated care models. The alignment of with the WHO guideline on \u0026lsquo;Integrated care models: an overview\u0026rsquo; (42) highlights the relevance of these components in enhancing clinical practice. Future research \u0026nbsp;should focus on evaluating the effectiveness of \u0026lsquo;hub\u0026rsquo; versus home based CGA for community-dwelling older adults.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe heterogeneity of research exploring patient reported outcomes is evident across community-based CGA interventions (19, 21). Future use of standardised assessments to assess functional status and HRQoL for community-based CGA is warranted (19), (21). Only 6 of the 22 included trials in the Cochrane Review by Briggs and colleagues measured HRQoL (19). Moreover, measurement of patient satisfaction or experience of community-based CGA was not included (19). This cohort study addressed this research gap through incorporating a person-centred perspective through inclusion of a PROM, \u0026nbsp;EQ-5D-5L (29). Given that implementation of PROMs, including HRQoL, that enable collaborative person-centred interventions enable more effective healthcare (23), HRQoL could be considered as a primary outcome for future RCTs that examine the impact of CGA. Furthermore, outcomes of this cohort study may be used to inform the design and delivery of future RCTs that examine the effectiveness of community-based CGA.\u003c/p\u003e\n\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\n\u003cp\u003eThis is the first study that explored person-centered integrated CGA as a model of care for older adults who are referred to and screened by their GP to a CST-OP in an Irish setting. The use of patient reported outcome measures is one of the key strengths of this study and the impact of care was explored at both clinical and process level. The low rates of attrition at 30 and 180 days further enhances the reliability of our findings. This multi-site study increases the generalizability of findings. The involvement of PPI involvement informing the included outcomes is another strength of the study. This study supports the growing emphasis in research and policy on adopting a community-based approach to the delivery of care to older adults.\u003c/p\u003e\n\u003cp\u003eAs a result of the observational design of this study, the lack of randomization and of a control group is a limitation to this study. Although the analysis controlled for confounding factors, the true effect of exposures and outcomes cannot be out ruled. The majority of the population were white Irish which may affect the generalisability of findings to more diverse populations. The self-reporting of functional status may incur recall bias. The composition of the population mainly comprised of white Irish, which may affect the generalizability of findings outside of this cohort.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe model of integrated care delivered by the CST-OP may improve outcomes and mitigate against potentially avoidable ED presentations and hospitalisations among community-dwelling older adults. Presence of frailty was a significant predictor for adverse outcomes at 30 and 180 days, and a score of \u0026sup3;5 on the CFS frail were associated with increased risk of functional decline, increased rates of mortality, NH admission, hospitalisation or ED presentation at 30 and 180 days. Although the functional status decreased at long-term follow-up, older adults\u0026rsquo; HRQoL significantly improved. Integrated care facilitating transfer of care away from the acute towards the primary care setting are key to the reform of healthcare delivery to older adults. Future research should consider the impact of a domiciliary based versus \u0026lsquo;hub\u0026rsquo; based integrated model of care on community-dwelling older adults, using RCT methodology.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCST OP, Community Specialist Teams for Older Persons; CGA, Comprehensive Geriatric Assessment; HRQoL, health-related quality of life; Emergency Department, ED; World Health Organization, WHO; multidisciplinary team, MDT; 21 randomised controlled trials, RCT; standardised mean difference, SMD; CI, confidence interval; FTE, full-time equivalent; CNS, clinical nurse specialist; ANP, advanced nurse practitioner; GP, General Practitioner; OTA, occupational therapist assistant; Clinical Frailty Scale, CFS; EuroQoL-5D-5L, EQ5D5L; Patient Assessment of Integrated Elderly Care, PAIEC; standard deviations, SD; interquartile ranges, IQR; PC, primary care; OR, odds ratio; NH, nursing home; hx, history.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adheres to the Declaration of Helsinki and ethical approval for the study was granted by the Research Ethics Committee, University of Limerick Hospitals Group, Mid-West Region (Ref. 116/2021). Hard copies of signed participant consent forms were obtained for all participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all participants who were recruited during the duration of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed within this study are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) report no conflicts of interest in this work.\u003cbr\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research is funded through the Health Research Board (HRB) of Ireland (Health Research Board, Grattan House 67-72 Lower Mount Street, Dublin 2, D02 H638, Ireland) under the HRB Research Leader Award RL-2020- 010.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCH conceptualised the study and was responsible for design of the work, analysis and interpretation of the data and writing the original draft preperation. RG was responsible for conceptualisation of the study, design of the work, analysis and interpretation of the data, supervision, and revised the manuscript from a critical perspective. AW reviewed data analysis. CH and CD were involved in the extraction of data. All authors including CH, RG, KR, CD, CF, BC, AL, MM, and AW contributed to the drafting and editing of the manuscript. All authors have read and approved the final draft of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding author is grateful to all participants and those important to them who were recruited to this study and engaged in follow-up CST-OP visit. She is also grateful to all co-authors who shared their knowledge, time and expertise during the study completion period.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Integrated care for older people: Guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva: World Health Organization; 2017.\u003c/li\u003e\n\u003cli\u003eDepartment of Health. Health Service Capacity Review 2018 Executive Report. Dublin; 2018 23 Jan 2018.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Integrated care for older people (ICOPE): realigning primary health care to respond to population ageing. . 2018.\u003c/li\u003e\n\u003cli\u003eBritish Geriatrics Society. Joining the dots: A blueprint for preventing and managing frailty in older people. United Kingdom; 2023.\u003c/li\u003e\n\u003cli\u003eClegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The lancet. 2013;381(9868):752-62.\u003c/li\u003e\n\u003cli\u003eFried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56(3):M146-M57.\u003c/li\u003e\n\u003cli\u003eKojima G, Iliffe S, Jivraj S, Walters K. Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis. J Epidemiol Community Health. 2016;70(7):716-21.\u003c/li\u003e\n\u003cli\u003eVermeiren S, Vella-Azzopardi R, Beckwee D, Habbig A-K, Scafoglieri A, Jansen B, et al. Frailty and the prediction of negative health outcomes: a meta-analysis. Journal of the American medical directors association. 2016;17(12):1163. e1-. e17.\u003c/li\u003e\n\u003cli\u003eKojima G. Frailty as a predictor of nursing home placement among community-dwelling older adults: a systematic review and meta-analysis. Journal of geriatric physical therapy. 2018;41(1):42-8.\u003c/li\u003e\n\u003cli\u003eShamliyan T, Talley KM, Ramakrishnan R, Kane RL. Association of frailty with survival: a systematic literature review. Ageing research reviews. 2013;12(2):719-36.\u003c/li\u003e\n\u003cli\u003eTILDA. TILDA Wave 5 Key Findings: The Older Population of Ireland on the Eve of the COVID-19 Pandemic. Dublin; 2020.\u003c/li\u003e\n\u003cli\u003eChristina Hayes MM, Christine Fitzgerald, Brian Condon, Anne Griffin, Margaret O\u0026rsquo;Connor, Liam Glynn, Katie Robinson, Rose Galvin. Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis. Health \u0026amp; Social Care in the Community. 2024.\u003c/li\u003e\n\u003cli\u003eLiljas AE, Brattstr\u0026ouml;m F, Burstr\u0026ouml;m B, Sch\u0026ouml;n P, Agerholm J. Impact of integrated care on patient-related outcomes among older people\u0026ndash;a systematic review. International journal of integrated care. 2019;19(3).\u003c/li\u003e\n\u003cli\u003eCondon B, Griffin A, Fitzgerald C, Shanahan E, Glynn L, O\u0026rsquo;Connor M, et al. Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis. BMC geriatrics. 2024;24(1):233.\u003c/li\u003e\n\u003cli\u003eJames Lind Alliance. Managing chronic conditions in Irish primary care https://www.jla.nihr.ac.uk/priority-setting-partnerships/managing-chronic-conditions-in-irish-primary-care/: James Lind Alliance 2024 [Available from: https://www.jla.nihr.ac.uk/priority-setting-partnerships/managing-chronic-conditions-in-irish-primary-care/.\u003c/li\u003e\n\u003cli\u003eICPOP Steering Group. Making a start in integrated care for older persons a practical guide to the local implementation of integrated care programmes for older persons. 2017.\u003c/li\u003e\n\u003cli\u003eNational Clinical Programme for Older People. Knowledge and Skills Framework for Healthcare Professionals Working with Older People. Dublin; 2023 08 Dec 2023.\u003c/li\u003e\n\u003cli\u003eEllis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database of Systematic Reviews. 2017(9).\u003c/li\u003e\n\u003cli\u003eBriggs R, McDonough A, Ellis G, Bennett K, O\u0026apos;Neill D, Robinson D. Comprehensive Geriatric Assessment for community‐dwelling, high‐risk, frail, older people. Cochrane Database of Systematic Reviews. 2022(5).\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. World Report on Ageing and Health. Geneva; 2015. Report No.: ISBN: 9789241565042.\u003c/li\u003e\n\u003cli\u003eHayes C, Amanuel Yigezu, Sarah Dillon, Christine Fitzgerald, Molly Manning, Aoife Leahy, et al. Home-based comprehensive geriatric assessment for community-dwelling, at-risk, frail older adults: A systematic review and meta-analysis. Journal of the American Geriatrics Society. 2025.\u003c/li\u003e\n\u003cli\u003eHayes C, Manning M, Fitzgerald C, Condon B, Griffin A, O\u0026rsquo;Connor M, et al. Effectiveness of Community‐Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta‐Analysis. Health \u0026amp; Social Care in the Community. 2024;2024(1):6437930.\u003c/li\u003e\n\u003cli\u003eVon Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. American College of Physicians; 1997. p. 1097-102.\u003c/li\u003e\n\u003cli\u003eVon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bulletin of the World Health Organization. 2007;85:867-72.\u003c/li\u003e\n\u003cli\u003eExecutive HS. National Framework for the Integrated Prevention and Management of Chronic Disease in Ireland 2020-2025. Dublin, Ireland: Health Service Executive; 2020.\u003c/li\u003e\n\u003cli\u003eExecutive HS. Practice Guidance for Older Person Multi-Disciplinary Teams. 2021.\u003c/li\u003e\n\u003cli\u003eRockwood K, Theou O. Using the clinical frailty scale in allocating scarce health care resources. Canadian Geriatrics Journal. 2020;23(3):210.\u003c/li\u003e\n\u003cli\u003eFi M. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61-5.\u003c/li\u003e\n\u003cli\u003eHerdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of life research. 2011;20:1727-36.\u003c/li\u003e\n\u003cli\u003eSasseville M, Smith SM, Freyne L, McDowell R, Boland F, Fortin M, Wallace E. Predicting poorer health outcomes in older community-dwelling patients with multimorbidity: prospective cohort study assessing the accuracy of different multimorbidity definitions. BMJ open. 2019;9(1):e023919.\u003c/li\u003e\n\u003cli\u003eDent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: a review. European journal of internal medicine. 2016;31:3-10.\u003c/li\u003e\n\u003cli\u003eChurch S, Rogers E, Rockwood K, Theou O. A scoping review of the Clinical Frailty Scale. BMC geriatrics. 2020;20:1-18.\u003c/li\u003e\n\u003cli\u003eField A. Discovering statistics using IBM SPSS statistics: Sage publications limited; 2024.\u003c/li\u003e\n\u003cli\u003eMetti AL, Best JR, Shaaban CE, Ganguli M, Rosano C. Longitudinal changes in physical function and physical activity in older adults. Age and ageing. 2018;47(4):558-64.\u003c/li\u003e\n\u003cli\u003eHajek A, Luck T, Brettschneider C, Posselt T, Lange C, Wiese B, et al. Factors affecting functional impairment among elderly Germans\u0026mdash;results of a longitudinal study. The Journal of nutrition, health and aging. 2017;21(3):299-306.\u003c/li\u003e\n\u003cli\u003eSaraiva MD, Rangel LF, Cunha JLL, Rotta TCA, Douradinho C, Khazaal EJB, et al. Prospective GERiatric Observational (ProGERO) study: cohort design and preliminary results. BMC geriatrics, unpublished data. 2020;20:1-12.\u003c/li\u003e\n\u003cli\u003eStringhini S, Carmeli C, Jokela M, Avenda\u0026ntilde;o M, McCrory C, d\u0026rsquo;Errico A, et al. Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study. bmj. 2018;360.\u003c/li\u003e\n\u003cli\u003eRubenstein LZ, Stuck AE, Siu AL, Wieland D. Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. Journal of the American Geriatrics Society. 1991;39(S1):8S-16S.\u003c/li\u003e\n\u003cli\u003eHayes C, Fitzgerald C, O\u0026rsquo;Shaughnessy \u0026Iacute;, Condon B, Leahy A, O\u0026rsquo;Connor M, et al. Exploring stakeholders\u0026rsquo; experiences of comprehensive geriatric assessment in the community and out-patient settings: a qualitative evidence synthesis. BMC Primary Care. 2023;24(1):274.\u003c/li\u003e\n\u003cli\u003eGilleard C, Hyde M, Higgs P. The impact of age, place, aging in place, and attachment to place on the well-being of the over 50s in England. Research on aging. 2007;29(6):590-605.\u003c/li\u003e\n\u003cli\u003eGobbens RJ. Frailty in Community-Dwelling Older People. Healthcare (Basel). 2023;11(16).\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Integrated care models: An overview Health Services Delivery Programme. Division of Health Systems and Public Health Copenhagen, Denmark; 2016.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Comprehensive geriatric assessment, community, out-patient, older adults, community-dwelling, frailty","lastPublishedDoi":"10.21203/rs.3.rs-5890108/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5890108/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u0026nbsp;This study explored the clinical and process outcomes of older adults at risk of or living with frailty who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the community.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u0026nbsp;\u003c/strong\u003eThis prospective cohort study recruited older adults aged ≥75 who were screened for frailty and referred to one of three CST-OP hubs in the Mid-West of Ireland by their GP. Follow-up assessments were conducted via telephone by an independent assessor at\u0026nbsp;30-and-180 days. The primary outcome was functional status. Secondary outcomes included primary healthcare use, secondary healthcare use, nursing home admission, health-related quality of life (HRQoL), patient satisfaction and mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u0026nbsp;A total of 303 participants (mean age=83.23 years) were recruited. Incidence of 30-and 180-day functional decline was 26.4% and 33.7% respectively. The majority of older adults who availed of community-based CGA maintained functional independence up to 6-months post index visit. At 30 days, the mortality rate was 1%, Emergency Department (ED) presentation 6.9%, hospitalisation 6.6% and nursing home admission 4%. HRQoL significantly improved at 30-and-180 days.\u0026nbsp;There was a significant improvement in HRQoL, F(2, 542)=13.839, p\u0026lt;0.001, η\u003csup\u003e2\u003c/sup\u003e=0.49.\u0026nbsp;The presence of frailty was a significant predictor of adverse outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u0026nbsp;Community-based CGA results in favorable health outcomes including HRQoL\u0026nbsp;among community-dwelling older adults. Community-based CGA may also\u0026nbsp;mitigate against potentially avoidable ED presentations and hospitalisations. Use\u0026nbsp;of the Clinical Frailty Scale is recommended to predict the \u0026nbsp;risk of functional decline, increased rates of mortality, NH admission, hospitalisation or ED presentation at 30 and 180 days among community-dwelling older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e: The study protocol was prospectively registered on Clinicaltrials.gov (NCT05527223). Registered January 09, 2022. https://clinicaltrials.gov.\u003c/p\u003e","manuscriptTitle":"Community Specialist Teams for Older Persons (CST-OP) at risk of, or living with frailty in Ireland: a prospective cohort study of a new model of integrated care for community dwelling older adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-09 11:43:25","doi":"10.21203/rs.3.rs-5890108/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-20T12:36:54+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"54148928313976706250317296792133974274","date":"2025-04-18T21:38:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215162090416061739609455518177313369758","date":"2025-04-15T09:07:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-13T14:27:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164198232704590809184564835578985967929","date":"2025-04-13T14:12:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T13:51:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245399878047899198423426350263576745653","date":"2025-04-07T22:27:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-07T22:18:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-03T09:19:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-04-02T15:10:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ff89426-1b7e-4462-943f-6235bc396f19","owner":[],"postedDate":"April 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-09T16:11:44+00:00","versionOfRecord":{"articleIdentity":"rs-5890108","link":"https://doi.org/10.1186/s12875-025-02895-x","journal":{"identity":"bmc-primary-care","isVorOnly":false,"title":"BMC Primary Care"},"publishedOn":"2025-06-05 15:57:40","publishedOnDateReadable":"June 5th, 2025"},"versionCreatedAt":"2025-04-09 11:43:25","video":"","vorDoi":"10.1186/s12875-025-02895-x","vorDoiUrl":"https://doi.org/10.1186/s12875-025-02895-x","workflowStages":[]},"version":"v1","identity":"rs-5890108","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5890108","identity":"rs-5890108","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}