Prospective follow-up study of elderly patients discharged from an accident and emergency department

Abstract

One hundred patients aged 75 years and over who were discharged from an accident and emergency department were selected at random for follow-up at home. Over half of the patients had suffered minor trauma, but 26 had increased dependency in one or more activities of daily living. Increased support was provided by the relatives for the majority of patients, by friends and neighbours in seven cases, and by a district nurse in 14, whilst only one patient received increased home help. Eight patients were known to be readmitted to hospital within 14 days of discharge. Staff in accident and emergency departments need to be aware that the functional consequences of an apparently minor injury in an elderly person may be severe, and that discharge must be carefully planned.

Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions

“…Overall, these studies showed that between 10% and 45% of older ED patients experience increased functional dependence in the 3 months after an emergency visit. 29,[31][32][33]36,37 It should be noted that the risk factors predicting adverse health outcomes in the ED studies of older adults reviewed in this section are consistent with the results of the previous large-scale studies of the predictors of ED and hospital use among representative samples of the community-living general older population. [41][42][43][44][45] These factors have also been recognized as indicators of frailty among older people and have generally been predictive of various adverse health outcomes in the elderly population.…”

“…For example, most studies that examined health outcomes among older ED patients excluded those living in residential and long-term care facilities. 28,29,31,33,40,54,58,63,70 Therefore, their results are not generalizable to this subgroup of the older population.…”

“…Overall, the findings indicate that older patients seeking emergency care are at high risk for adverse health outcomes (ie, functional decline, hospitalization, ED return, death) in the 6 months after their ED index visit. 1,[28][29][30][31][32][33][34][35][36][37][38][39][40] As shown in Table 2, baseline functional dependence was the most prevalent risk factor predicting various adverse outcomes among elderly ED patients, identified in 7 of the 10 studies reviewed. [28][29][30]34,35,39,40 Among other common risk factors cited in 3 or more studies were advanced age, recent hospitalization or ED visit, living alone, and lack of social support.…”

“…2,12,21,25 In fact, emergency physicians report greater difficulty managing older patients with various emergency clinical presenta- Table 1. 30 Four Canadian 221 ≥65 Risk factors for functional disability * : age, living NA hospitals alone, poor self-rated health, premorbid need for help, recent decline in function, history of diabetes, memory impairment, social isolation Sayers (1997) 31 Irish hospital 100 ≥65 NA 10%: ↑ dependence in ADL; 28%: ↑ dependence in IADL; 3%: hospital admission after D/C Lowenstein et al (1986) 1 American hospital 234 ≥65 NA 10%: ED return in patients age 65-75 y; 29%: ED return in patients age >75 y Angelos (1993) 32 American hospital 189 ≥65 NA 34%: ↑ dependence; 16%: ED return; 11%: hospital admission after D/C Rowland et al (1990) 29 British hospital 450 ≥75 Risk factors for hospital admission † : dependence 43%: ↑ dependence; 6%: hospital admission after D/C for mobility, dependence for shopping, dependence for dressing, use of Meals on Wheels, use of Home Help, attending a day center, attending a hospital day unit Roberts (1990) 33 British hospital 100 ≥75 NA 26%: ↑ dependence; 8%: hospital admission after D/C Follow-up period of 3 mo Chin et al (1999) 34 American hospital 983 ≥65 Risk factors for poor recovery * : lack of adequate 10%: mortality help, greater baseline functional impairment, comorbidity, proxy responding McCusker et al (1997) 35 Canadian hospital 167 ≥75 Risk factors for ED return * : male sex, living alone, 24%: ED return greater functional problems Richardson (1992) 36 Australian hospital 191 ≥75 Risk factors for mortality † : fractured neck or 10%: ↑ dependence; 12%: mortality femur, cardiac failure; risk factors for mortality or dependence * : social-placement problem, referral by other than family, neurologic disease, cardiac failure, assessed as needing admission Rosenfeld et al (1990) 37 Australian the screened patients. 56,57 However, there were no evaluations of the clinical outcomes.…”

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

“…Healthy People 2020, a division of the U.S. Department of Health and Human Services (HHS), has identified reducing the rate of ED visits from falls in the elderly as a national health priority [2]. Older adults are at high risk for poor outcomes (including death, functional decline, adverse events, increased level of care, inpatient hospitalization) after ED visits as compared to younger adults [3–18]. Approximately 25% of older adults seen and discharged in the ED for any cause are readmitted soon thereafter [19], but the incidence of readmission after injury is not known.…”