Reproducible case-finding rule identifies frequent-attender frail patients for proactive assessment

A baseline analysis of the Swedish GerMoT trial — a randomised controlled trial comparing proactive outpatient care based on Comprehensive Geriatric Assessment with usual care — describes the 450 participants recruited using a simple case-finding rule: aged 75 or over, three or more emergency department visits in the previous 18 months, three or more diagnosed conditions across different ICD-10 chapters, and living at home [Primary Study]. The resulting group carried a high multimorbidity burden (a mean of 7.2 diagnoses across ICD-10 chapters) and high rates of pain (80%) and mobility problems (64%), but comparatively low frailty (60% non-frail, 13% severely frail) and largely preserved independence (90% independent or partially independent with basic activities of daily living).

This is a baseline characterisation of trial-eligible patients, not a report of the GerMoT trial’s comparative outcomes — those results, testing whether proactive Comprehensive Geriatric Assessment actually improves on usual care for this group, have not yet been published. What the analysis does establish is that a four-criterion rule based on age, attendance frequency, morbidity count and living arrangement identifies a distinct population: high in pain and mobility need but not predominantly frail in the conventional sense.

For services deciding which patients to prioritise for proactive community geriatric assessment, this offers a pragmatic, low-cost identification method that does not depend on frailty scoring alone. Its ultimate value will depend on GerMoT’s still-unpublished comparative results confirming that acting on this case-finding rule improves outcomes relative to usual care.