The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients
Corresponding Author
Ula Hwang
Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
Correspondence:
Ula Hwang ([email protected])
Search for more papers by this authorNatalia Sifnugel
Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
Search for more papers by this authorInessa Cohen
Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
Program of Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA
Search for more papers by this authorLing Han
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorKaty Araujo
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorLuann M. Bianco
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorCynthia A. Brandt
Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorSandra Capelli
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorChristopher R. Carpenter
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Search for more papers by this authorDaniel S. Cruz
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorScott M. Dresden
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorIvy L. Fishman
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorKatrina Gipson
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Search for more papers by this authorS. Nicole Hastings
Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
Search for more papers by this authorWilliam W. Hung
Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Search for more papers by this authorRaymond Kang
Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorMechelle Lockhart
Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Search for more papers by this authorDaniella Meeker
Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorUgochi Ohuabunwa
Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Search for more papers by this authorSierra Ottilie-Kovelman
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorCaitlin Partridge
Joint Data Analysis Team (JDAT), Yale Biomedical Informatics and Computing, Research Informatics Office, Yale University, New Haven, Connecticut, USA
Search for more papers by this authorTimothy F. Platts-Mills
Ophirex, Inc., Corte Madera, California, USA
Search for more papers by this authorJacqueline Sandoval
Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorZachary Taylor
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorDebra F. Tomasino
Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
Search for more papers by this authorCamille P. Vaughan
Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
VA Atlanta Health Care System, Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC) Atlanta, Atlanta, Georgia, USA
Search for more papers by this authorCorresponding Author
Ula Hwang
Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
Correspondence:
Ula Hwang ([email protected])
Search for more papers by this authorNatalia Sifnugel
Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
Search for more papers by this authorInessa Cohen
Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
Program of Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA
Search for more papers by this authorLing Han
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorKaty Araujo
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorLuann M. Bianco
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorCynthia A. Brandt
Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorSandra Capelli
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorChristopher R. Carpenter
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Search for more papers by this authorDaniel S. Cruz
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorScott M. Dresden
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorIvy L. Fishman
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorKatrina Gipson
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Search for more papers by this authorS. Nicole Hastings
Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
Search for more papers by this authorWilliam W. Hung
Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Search for more papers by this authorRaymond Kang
Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorMechelle Lockhart
Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Search for more papers by this authorDaniella Meeker
Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorUgochi Ohuabunwa
Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
Search for more papers by this authorSierra Ottilie-Kovelman
Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorCaitlin Partridge
Joint Data Analysis Team (JDAT), Yale Biomedical Informatics and Computing, Research Informatics Office, Yale University, New Haven, Connecticut, USA
Search for more papers by this authorTimothy F. Platts-Mills
Ophirex, Inc., Corte Madera, California, USA
Search for more papers by this authorJacqueline Sandoval
Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Search for more papers by this authorZachary Taylor
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Search for more papers by this authorDebra F. Tomasino
Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
Search for more papers by this authorCamille P. Vaughan
Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
VA Atlanta Health Care System, Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC) Atlanta, Atlanta, Georgia, USA
Search for more papers by this authorFunding: Supported by National Institute on Aging (NIA) of the National Institutes of Health (NIH; R33AG058926). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript.
Supervising Editor: Beau Abar
Presentation: Geriatric Emergency Care Applied Research Network Consensus Conference, October 25–26, 2019, Denver, CO, USA, Society for Academic Emergency Medicine Conference, May 13–16, 2025, Philadelphia, PA, USA.
ABSTRACT
Objectives
Multicenter research of geriatric emergency department (GED) care remains limited. Our objectives were to: 1. Prospectively collect data prioritized by the Geriatric Emergency care Applied Research (GEAR) network, a transdisciplinary taskforce for GED care, and create a multicenter GED research repository of prospective and electronic health record (EHR) data, 2. Assess concordance between prospective and EHR data.
Methods
The GEAR Standardization Study (GEARSS) is a multicenter, prospective study of older emergency department (ED) patients (65+) focusing on the 4Ms of age-friendly care (mobility, medication safety, mentation, what matters) and elder mistreatment. Demographic and clinical data were collected via interviews by trained research assistants (RA) on Days 0, 4, 30, and 90 and linked to EHR. Prevalence of chronic comorbidities and incident delirium were measured and reported using descriptive statistics. Prospective and EHR data concordance was assessed with Cohen's Kappa.
Results
999 participants were recruited from 5 EDs (3/25/2021–6/30/2022) across 3 institutions: Grady Health System, Northwestern Memorial Hospital, and Yale New Haven Health. The cohort was 57.0% female, 55.2% White, 39.1% Black, and 3.4% Hispanic, and the mean age was 75.1 years. For rheumatologic disease, peptic ulcer disease, diabetes, renal disease, and cancer, prevalence differed between prospective and EHR data by > 10%. About two-thirds of participants were at risk for falls. Concordance between prospective and EHR data was good for ethnicity (K = 0.73); excellent for sex (K = 1.00), age (K = 1.00), and race (K = 0.98); fair for disposition (K = 0.53); slight for ED observation status (K = 0.33) and dementia diagnosis (K = 0.24); poor for delirium presence (K = 0.07).
Conclusion
In GEARSS, demographic variables aligned strongly between prospective and EHR data, while diagnosis, disposition, and mentation factors did not. This multicenter data source provides preliminary findings for common geriatric syndromes and conditions. Choice of measures using these data should be driven by GED research questions.
Conflicts of Interest
C.R.C. is Associate Editor for the Journal of the American Geriatrics Society, leads the Society for Academic Emergency Medicine Guidelines for Reasonable and Appropriate Care in the Emergency Department committee, serves on the American College of Emergency Physicians Clinical Policy Committee, is Chair of the American College of Emergency Physicians Geriatric Emergency Department Accreditation Advisory Board, serves on the Clinician–Scientist Transdisciplinary Aging Research Leadership Core, and is an editor for the American College of Emergency Physicians MyEMCert program.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
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| acem70101-sup-0001-TableS1.docxWord 2007 document , 81.9 KB |
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| acem70101-sup-0002-TableS2.pdfPDF document, 66.6 KB |
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| acem70101-sup-0003-TableS3.pdfPDF document, 67.5 KB |
Table S3. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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