health care utilization, nursing home admission, and mortality. ED utilization is increasing rapidly in this population, and previous studies have identified selfreported data, including sex, living status, and functionality, as risk factors for short-term repeat ED visits. Our objective was to assess the association of baseline functional and health status and social engagement with repeat ED visits among older adults.Methods: We conducted a prospective cohort study of 160 adults !65 who visited the ED of an urban, academic, medical center between Feb 2017 and Jan 2018. Subjects were interviewed at their index encounter to establish their functional, cognitive and health status, and social engagement; and followed up via telephone interview at 3, 6, 9 and 12 months. Measures included shortened versions of the Katz Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living (IADL), Lubben Social Network Scale (LNS) and Older People's Quality of Life Questionnaire (OPQoL). Medical record review was also conducted. The primary outcome for this analysis was repeat ED visits within a year of the index visit. Comparisons were made using Chi-square tests, Student's t-tests and Wilcoxon rank sum tests, as appropriate. Multivariable logistic regression was used to identify independent associations of functional and health status and social engagement, with repeat ED visits.Results: Among 160 subjects, 72 (45%) had a repeat visit to the ED. Subjects had a median of 1 (IQR, 1 -3) repeat visits. The first repeat visit occurred within a median of 112 (IQR, 30 -231) days of the index visit. Mean age was 75AE7 years and 53% were female; age and sex were similar between groups. Those that returned to the ED, compared to those who did not return, had lower baseline ADL (median (IQR): 6 (5, 6) vs 6 (6, 6); P¼0.002), IADL (7 (6, 8) vs 8 (7, 8); P¼0.048) and LNS scores (mean (SD): 15.11 (6.57) vs 17.74 (6.51); P¼0.014). OPQoL scores were similar between the two groups (% reporting a "good" quality of life: 89% vs 88%; P¼1.00). Adjusting for age and sex, ADL (OR, 95% CI: 0.68, 0.49-0.94; P¼0.020), IADL (0.81, 0.65-1.00; P¼ 0.053) and LNS (0.94, 0.89-0.98; P¼0.010), were observed to be associated with repeat ED visits. Adjusting for all factors, only LNS remained significantly associated with repeat ED visits (0.94, 0.89-0.99; P¼0.020).Conclusions: Nearly half of all subjects had a repeat ED visit within one year following their index visit. Lower functional status (ADL, IADL) and social engagement (LNS) were associated with return to the ED. While previous studies have looked at predictors of repeat ED visits in older adults, they focused on short term repeat visits. Our findings extend to long-term follow-up and support the need for further research on the utility of screening for functional status and social engagement among older adults in the ED.
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