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This research has helped to transform the care of older adults in Emergency Departments (EDs) across Ireland. By introducing specialist Health and Social Care Professional teams focused on timely assessment and smoother transitions home, older adults have experienced shorter wait times, better recovery and fewer hospital readmissions.

The OPTIMEND model, first trialled at University Hospital Limerick, now exists in most EDs nationally. With savings of approximately €6,000 per patient, the research now informs national healthcare policy — showing how evidence-based research, grounded in the voices of older people, can improve wellbeing, support public services and deliver better value for the health system.

Beneficiaries

older adults attending Emergency Departments, HSE, hospital teams, policymakers, health educators, healthcare practitioners

Description of the impact

As Ireland’s population ages faster than anywhere else in Europe, Emergency Departments (EDs) are under growing pressure. Older adults account for around one in four ED visits yet consistently experience poorer outcomes than other groups. They often face longer waits, functional decline, loss of independence and a higher chance of returning to hospital shortly after discharge. In a health system already at capacity, this creates a cycle that is both distressing for older people and unsustainable for public services.

In response, a ������ research team has developed and trialled a new approach that places the needs and voices of older adults at the heart of ED care. Feedback from older people and previous research reveals key challenges like unresolved symptoms after discharge, poor communication, and fragmented follow-up care (Condon et al, 2023). These insights informed the design of two research-led interventions: OPTIMEND and ED PLUS.

OPTIMEND introduced dedicated Health and Social Care Professional (HSCP) teams within the University Hospital Limerick ED, providing timely assessment and coordinating care for people aged 65 and over. A total of 353 older adults participated in the study. The impact was both immediate and tangible. Compared to those receiving standard care, older adults supported by the HSCP team experienced shorter wait times, better mobility and quality of life, and were less likely to be readmitted to hospital. This approach also proved cost-effective, delivering estimated savings of €6,000 per person (Source 1).

The ED PLUS pilot trial went a step further, testing an HSCP-led model that supported older people as they transitioned from the ED back into the community. This trial showed the model to be safe, feasible and beneficial: at six-week and six-month follow-ups, no participants in the ED PLUS group had returned to hospital, unlike those in comparison groups. Participants reported improved mobility, independence, and overall wellbeing ().

These findings are changing how emergency care is delivered in Ireland. Today, dedicated HSCP teams are in place in most EDs nationwide, supported by national policy and informed by this research. The work has also prompted additional grant funding to further develop and evaluate interdisciplinary models of care for older people, ensuring continuous learning and improvement.

The impact is both practical and personal. It has helped older adults feel more supported, more involved in their care, and more confident when leaving the ED. As clinical specialist occupational therapist and ARC PhD graduate, Dr Íde O’Shaughnessy put it: “We are looking at the same person but with different perspectives and a different lens. This collaborative and holistic approach, that is responsive to the changing needs and preferences of older adults, has undoubtedly enhanced the quality of care of those who attend the ED.”

This case highlights the value of publicly funded research in addressing real-world challenges — demonstrating accountability to society, guiding future funding allocation, and supporting national health policy with robust evidence of what works best and why. It shows that research, when designed with and for the people it aims to support, can be a positive and practical force for change.

Evidence of impact

1. The outputs from this programme of research address key objectives outlined in national and international strategies relating to emergency and integrated care for older adults. Findings from the OPTIMEND study have been cited as an evidence-based model of practice in the national Health and Social Care Professions Strategy 2021–2026 (HSCP Deliver), pages 90–91. ().
2. The Ageing Research Centre (ARC) has developed a close relationship with the National Clinical Advisor and Group Lead for Older Persons (NCAGL OP) to support fidelity to service models for older adults attending Emergency Departments across Ireland. Following a national meeting at UL involving over 80 representatives from EDs nationwide, a set of national consensus guidelines was developed to define core standards of care for older adults, known as Frailty at the Front Door Services. , alongside a practical guidance document currently in development, has directly influenced the training and education of ED staff, and contributed to improved quality and timeliness of care for older adults.
3. Dr Emer Ahern, National Clinical Advisor and Group Lead for Older People (NCAGL OP) commented: “Our collaboration with the Ageing Research Centre at UL has been instrumental in addressing fidelity to health service models for older adults, identifying new research priorities, and translating existing research into delivering the most substantial reform of older person services undertaken in decades in Ireland. The academic weight, integrity and credibility of ARC’s input into our mission has been critical to mobilising change in service design, delivery and outcomes.”
4. Testimonial from Una Breen, Ageing Research Centre stakeholder panel member: “Being part of the Ageing Research Centre, I actually think it’s amazing. The Ageing Research Centre has allowed older people like myself to actually have a voice. We’re not looking for the earth really, we’re just looking to be treated like human beings - and it’s lovely. The Ageing Research Centre does that.”

The findings from the OPTIMEND study have been publicly disseminated by the HSE through the , helping to raise awareness of the research and its relevance among healthcare staff, system leaders and the wider public. The article, titled “Research finds significant benefits for older patients who receive comprehensive geriatric assessment in ED,” highlights the study’s demonstration of shorter wait times, reduced admissions, and better outcomes for older adults following early HSCP assessment in the ED. It also reinforces the credibility and visibility of the research at a national level.

Research description

This research addressed a critical gap in how Emergency Departments (EDs) care for older adults, who often present with complex needs and face long wait times, fragmented care, and poorer outcomes. While interdisciplinary Health and Social Care Professional (HSCP) teams had shown promise in emergency settings, robust evidence on their effectiveness was limited.

To test this model, the ������ team designed and led OPTIMEND, a single-site randomised controlled trial (RCT) at University Hospital Limerick. Conducted from December 2018 to May 2019, the study involved 353 older adults. Half received the standard model of care, while the other half received early assessment and tailored interventions from a dedicated HSCP team (senior physiotherapist, occupational therapist and medical social worker).

The results were compelling. Older adults who received HSCP input spent significantly less time in the ED (median 7.33 vs. 14.15 hours) and were far less likely to be admitted to hospital (18.6% vs. 60%). The HSCP team carried out holistic assessments of mobility, cognition, psychosocial needs and function, supporting safe and timely discharge.

This research provides the first high-quality clinical evidence in Ireland supporting the role of integrated HSCP teams in EDs. The findings offer a new model of emergency care that is evidence-based, person-centred and responsive to the needs of older adults. Co-designed with patient input, the study also contributed to advancing knowledge on care transitions and interdisciplinary working — with direct implications for national healthcare policy and service design.

Research outputs

1. Condon, B., Griffin, A., Fitzgerald, C., Shanahan, E., Glynn, L., O’Connor, M., Hayes, C., Manning, M., Galvin, R., Leahy, A. and Robinson, K., 2024. Older adults’ experience of transition to the community from the emergency department: a qualitative evidence synthesis. BMC Geriatrics, 24(1), p.233.
2. Robinson, K. and Galvin, R., 2023. New care models for older adults seeking emergency care. Open Access Government, July, pp.206–207. Available at: [Accessed 16 Apr. 2025].
3. Cassarino, M., Quinn, R., Boland, F., Ward, M.E., McNamara, R., O’Connor, M., McCarthy, G., Ryan, D., Galvin, R. and Robinson, K., 2020. Stakeholders’ perspectives on models of care in the emergency department and the introduction of health and social care professional teams: a qualitative analysis using World Cafés and interviews. Health Expectations, 23(5), pp.1065–1073.
4. Cassarino, M., Robinson, K., Trépel, D., O’Shaughnessy, Í., Smalle, E., White, S., Devlin, C., Quinn, R., Boland, F., Ward, M.E., McNamara, R., Steed, F., O’Connor, M., O’Regan, A., McCarthy, G., Ryan, D. and Galvin, R., 2021. Impact of assessment and intervention by a health and social care professional team in the emergency department on the quality, safety, and clinical effectiveness of care for older adults: a randomised controlled trial. PLOS Medicine, 18(7), p.e1003711.
5. Conneely, M., Leahy, A., O’Connor, M., Barry, L., Corey, G., Griffin, A., O’Shaughnessy, Í., O’Carroll, I., Leahy, S., Trépel, D., Ryan, D., Robinson, K. and Galvin, R., 2022. A physiotherapy-led transition to home intervention for older adults following emergency department discharge: protocol for a pilot feasibility randomised controlled trial. Pilot and Feasibility Studies, 8, pp.1–14.
6. O'Shaughnessy, Í., Fitzgerald, C., Whiston, A., Harnett, P., Whitty, H., Mulligan, D., Mullaney, M., Devaney, C., Lang, D., Hardiman, J. and Condon, B., 2023. Establishing the core elements of a frailty at the front door model of care using a modified real-time Delphi technique. BMC Emergency Medicine, 23(1), p.123.

Research grants

This programme of research was supported by the following unrestricted research grants:

• Health Research Board of Ireland, Research Collaborative in Quality and Patient Safety 2017 (HRB RCQPS 2017-02)
• Health Service Executive, National Emergency Medicine Programme 2017 (HSE NEMP 2017)
• Health Research Board of Ireland, Investigator-Led Projects 2017 (HRB ILP 2017-014)
• Health Research Board of Ireland, Collaborative Doctoral Awards 2018 (HRB CDA 2018-02)

In addition, the OPTIMEND model of care was a new initiative for the Emergency Department at University Hospital Limerick. The Executive Team at UL Hospitals Group has provided continued funding for the HSCP team beyond the duration of the study.