Predictors of Admission After Emergency Department Discharge in Older Adults

Abstract

Objectives To identify predictors of hospital inpatient admission of older Medicare patients following discharge from the emergency department. Design Retrospective cohort study Setting 284 non-federal California hospitals Participants 505,315 visits of patients age >65 years (yrs) with Medicare insurance discharged from California EDs in 2007. Measurement Using the California Office of Statewide Health Planning and Development files, predictors of a hospital inpatient admission within 7 days of ED discharge in older adults (age > 65 yrs) with Medicare were evaluated. Results Hospital inpatient admissions within 7-days of ED discharge occurred in 23,340 (4.6%) visits and were associated with older age (Age 70–74 Adjusted Odds Ration=AOR 1.12, 95% Confidence Interval=CI 1.07–1.17; Age 75–79 AOR 1.18, 95% CI 1.13–1.23; Age 80+ AOR 1.4, 95% CI 1.35–1.46), skilled nursing facility use (AOR 1.82, 95% CI 1.72–1.94), leaving the ED against medical advice (AOR 1.82, 95% CI 1.67–1.98), and the following diagnoses with the highest odds of admission: End Stage Renal Disease (AOR 3.83, 95% CI 2.42–6.08), chronic renal disease (AOR 3.19, 95% CI 2.26–4.49), and congestive heart failure (AOR 3.01, 95% CI 2.59–3.50). Conclusion A total of 4.6% of older adults with Medicare insurance have a hospital inpatient admission after discharge. Chronic conditions such as renal disease and heart failure were associated with the greatest odds of admission.

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

“…Our findings also replicate previous reports that those who identify as Hispanic have decreased odds of inpatient admission soon after a treat-and-release ED visit [20]. …”

“…Our inpatient admission rate after injury of 3.9% within 9 days and 7.8% within 30 days is similar to the inpatient admission rate within 7 days of 4.6% after all causes ED visits in older adults in California [20]. Unlike Gabayan et al, however, we did not find that older age was a risk factor, perhaps because we adjusted for the number of chronic comorbidities, which is closely associated with increasing age.…”

Emergency Department Vital Signs and Outcomes After Discharge

“…A diagnosis of mental illness includes dementia, mood disorders, depression, and substance-related disorders. Although this is a different study with a different population, our finding in this study are similar to our prior work in that we found cognitive impairment 43 and chronic medical conditions 44 to be associated with a poor outcome after ED discharge in older adults. Patients with mental illness possibly have a diagnosis masked by the mental illness or are suffering an impairment in mental judgment and are unable to follow ED after care instructions.…”

Poor Outcomes After Emergency Department Discharge of the Elderly: A Case-Control Study

“…In accordance with previous literature 2,4,5 and clinical judgment, we then matched all case patients to eligible controls 1:1, using a daisy cluster algorithm that allows all variable types to be matched, not just numeric variables, 10 without replacement according to the following parameters: age, sex, Emergency Severity Index 11 score, Charlson comorbidity index score, 12 and discharge diagnosis. Sex, Emergency Severity Index score, and discharge diagnosis were perfect matches.…”