Older Adult Patients in the Emergency Department: Which Patients should be Selected for a Different Approach?
- Author:
Nere Larrea AGUIRRE
1
;
Susana García GUTIÉRREZ
;
Oscar MIRO
;
Sira AGUILÓ
;
Javier JACOB
;
Aitor ALQUÉZAR-ARBÉ
;
Guillermo BURILLO
;
Cesáreo FERNANDEZ
;
Pere LLORENS
;
Cesar Roza ALONSO
;
Ivana Tavasci LOPEZ
;
Mónica CAÑETE
;
Pedro Ruiz ASENSIO
;
Beatriz Paderne DÍAZ
;
Teresa Pablos PIZARRO
;
Rigoberto Jesús del Rio NAVARRO
;
Núria Perelló VIOLA
;
Lourdes HERNÁNDEZ-CASTELLS
;
Alejandro Cortés SOLER
;
Elena SÁNCHEZ FERNÁNDEZ-LINARES
;
Jesús Ángel Sánchez SERRANO
;
Patxi EZPONDA
;
Andrea Martínez LORENZO
;
Juan Vicente Ortega LIARTE
;
Susana Sánchez RAMÓN
;
Asumpta Ruiz ARANDA
;
Francisco Javier MARTÍN-SÁNCHEZ
;
Juan González DEL CASTILLO
;
Author Information
- Publication Type:Original Article
- From: Annals of Geriatric Medicine and Research 2024;28(1):9-19
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:While multidimensional and interdisciplinary assessment of older adult patients improves their short-term outcomes after evaluation in the emergency department (ED), this assessment is time-consuming and ill-suited for the busy environment. Thus, identifying patients who will benefit from this strategy is challenging. Therefore, this study aimed to identify older adult patients suitable for a different ED approach as well as independent variables associated with poor short-term clinical outcomes.
Methods:We included all patients ≥65 years attending 52 EDs in Spain over 7 days. Sociodemographic, comorbidity, and baseline functional status data were collected. The outcomes were 30-day mortality, re-presentation, hospital readmission, and the composite of all outcomes.
Results:During the study among 96,014 patients evaluated in the ED, we included 23,338 patients ≥65 years—mean age, 78.4±8.1 years; 12,626 (54.1%) women. During follow-up, 5,776 patients (24.75%) had poor outcomes after evaluation in the ED: 1,140 (4.88%) died, 4,640 (20.51) returned to the ED, and 1,739 (7.69%) were readmitted 30 days after discharge following the index visit. A model including male sex, age ≥75 years, arrival by ambulance, Charlson Comorbidity Index ≥3, and functional impairment had a C-index of 0.81 (95% confidence interval, 0.80–0.82) for 30-day mortality.
Conclusion:Male sex, age ≥75 years, arrival by ambulance, functional impairment, or severe comorbidity are features of patients who could benefit from approaches in the ED different from the common triage to improve the poor short-term outcomes of this population.
