Factors associated with hospital admission after an emergency department treat and release visit for older adults with injuries

Abstract

Introduction Emergency Department (ED) visits for injury often precede hospital admissions in older adults, but risk factors for these admissions are poorly characterized. We sought to determine the incidence and risk factors for hospitalization shortly following discharge home from an ED visit for traumatic injury in older adults. We hypothesized higher risk for admission in those with increased age, discharged home after falls, with increased comorbidity burden, and who live in poor neighborhoods. Methods We identified all community-dwelling patients ≥65 years old treated and released for traumatic injury at non-federal EDs in Florida using the 2011 State Inpatient Database and State ED Database of the Agency for Healthcare Research and Quality. Outcome measures were hospitalization within 9 and 30 days of discharge from the ED. Multivariable logistic regression was used to establish independent risk factors for hospital admission. Results Of 163,851 index ED injury visits, 6298 (3.8%) resulted in inpatient admissions within 9 days and 12,938 (7.9%) within 30 days. Factors associated with increased odds of admission within 9 days included; each additional comorbidity, ≥moderate injury to abdomen or pelvis/extremities, and median neighborhood income < $39,000. Additional factors associated with increased odds of admission within 30 days included: lack of private insurance supplement and median neighborhood income < $48,000. Conclusion Among older adults treated and discharged from the ED for an injury, those who have high comorbidity burdens, have abdominal or orthopedic injuries, and live in poor neighborhoods are at increased risk of hospitalization within 9 or 30 days of ED discharge.

Poor Self-Rated Health Is Associated with Hospitalization and Emergency Department Visits in African American Older Adults with Diabetes

“…At the same time, marginalized, underserved, low socioeconomic status (SES) and racial/ethnic minority populations who are more likely to have multiple CMCs are at an increased risk of hospitalization and ED visits [6]. Living in economically disadvantaged areas (low SES neighborhoods) is also associated with increased risk of hospitalization and with higher likelihood of visiting the ED [7].…”

Analysis of traumatic event emergency department visits among care home residents aged 65 + years in Southern Jutland, Denmark: implications for comprehensive care and subsequent hospital admissions - a register-based cohort study

“…Our discovery that 73% of subsequent admissions stem from a wide range of non-injury-related medical issues is a key finding in our study, and it confirms our initial hypothesis: The event (often a ground-level fall) that resulted in the injury might indicate an undetected disease. A recent study on community-dwelling older adults in the USA who were treated for injuries and released from the ED showed a readmission rate of 7.9% within 30 days, hereof 64.5% due to non-trauma [ 17 ]. This highlights that a traumatic event such as a fall can indicate an incipient acute illness such as an infection or a deterioration of chronic disease.…”

“…pneumonia or delirium. A study showed that 8% of community-dwelling older adults treated for a traumatic injury (69% fall-related) and released from the ED experienced an in-hospital admission within the next 30 days, hereof 64.5% due to non-traumatic illnesses such as infections and congestive heart failure [ 17 ]. It is very difficult to distinguish whether the acute illness arose before or as a consequence of the fall that resulted in an ED visit.…”

Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles

“…Older adults often experience adverse events after an ED visit [9]. Low neighborhood income and high comorbidity status are contributing risk factors for in-patient hospitalization within 30 days of an ED visit among older adults [10].…”