Does functional decline prompt emergency department visits and admission in older patients?
BACKGROUND
Older patients may visit the emergency department (ED) when their illness affects their function.


OBJECTIVE
To quantify the function of older ED patients, to assess whether functional decline (FD) had occurred, and to determine whether function contributes to the ED visit and hospital admission.


METHODS
The authors performed an institutional review board-approved, prospective, cross-sectional study in a community teaching hospital ED. Eligible patients were older than 74 years of age, with an illness at least 48 hours old. Patients from a nursing facility and those without a proxy who were unable or unwilling to complete the questions were excluded. The Older Americans Resources and Services Questionnaire, which tests seven instrumental activities of daily living (IADL) and seven physical ADLs (PADL), was used. Data are presented as means or proportions with 95% confidence intervals (95% CI), and comparisons as 95% CI for the difference between proportions.


RESULTS
The authors enrolled 90 patients (mean age, 81.6 yr [SD +/- 4.9], 40% male). Dependence in at least one IADL was reported by 68% (95% CI = 57% to 77%), and in at least one PADL by 61% (95% CI = 50% to 71%). Functional decline was reported by 74% (95% CI = 64% to 83%). Two thirds of those with IADL decline and three quarters of those with PADL decline said that this contributed to their ED visit. Seventy-seven percent with, and 63% without, IADL decline were admitted (14% difference, 95% CI = -6.1% to 33%). Seventy-nine percent with and 61% without PADL decline were admitted (18% difference, 95% CI = -1.4% to 38%).


CONCLUSIONS
Functional decline is common in older ED patients and contributes to ED visits in older patients; its role in admission is unclear.
Wilber
Scott T
ST
Summa Health System, Northeastern Ohio Universities College of Medicine, Akron, OH 44309, USA. wilbers@summa-health.org
Blanda
Michelle
M
Gerson
Lowell W
LW
D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D009820:Ohio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D017678:Sex Distribution