Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective

Abstract

Objective To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge.Methods A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit.Results A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023).Conclusion The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.

Analysis of Medical Management in Geriatric Patients in the Hospital Emergency Department by Example of Selected Cities with County Status in Poland: A Retrospective Cohort Study

“…A decision not to use the ABCDE approach was often based on the first clinical impression or vital signs during segregation [ 26 ]. Dos Santos et al [ 27 ] conducted a cross-sectional study in a general public hospital among 255 older patients > 65 years of age. A visit to HED was defined as an older patient’s stay of ≤24 h. Medical segregation was performed in 99.3% of all patients, whereas the assessment of vital signs (heart rate and blood pressure) was performed in 98.6% of the older individuals.…”

“…A visit to HED was defined as an older patient’s stay of ≤24 h. Medical segregation was performed in 99.3% of all patients, whereas the assessment of vital signs (heart rate and blood pressure) was performed in 98.6% of the older individuals. Furthermore, 75.1% of all patients required ECG, intravenous cannula insertion, and pharmacotherapy [ 27 ]. The results for medical procedures performed at HED are comparable.…”

Transitional Care Based e-Health Program for Older Muslim Thai Adults with Chronic Obstructive Pulmonary Disease After Hospital Discharge: A Feasibility Study

“…6 Additionally, the use of emergency services after hospital discharge reflects the inadequacy of the transitional care process. 7 Transitional care for older adults is essential because it can minimize medication errors and adverse drug events and help prevent a lack of timely follow-up care and unnecessary ED visits. 8 To avoid discontinuity of treatment and adverse effects on older adults, transitional care is required.…”