title: Characteristics and outcomes of older persons attending the emergency department: a retrospective cohort study.
abstract: BACKGROUND
  The analysis of routinely collected hospital data informs the design of specialist services for at-risk older people.
  
  
  OBJECTIVE
  Describe the outcomes of a cohort of older emergency department (ED) attendees and identify predictors of these outcomes.
  
  
  METHODS
  retrospective cohort study.
  
  
  METHODS
  All patients aged 65 years or older attending an urban university hospital ED in January 2012 were included (N = 550). Outcomes were retrospectively followed for 12 months. Statistical analyses were based on multivariate binary logistic regression models and classification trees.
  
  
  RESULTS
  Of N = 550, 40.5% spent ≤6 h in the ED, but the proportion was 22.4% among those older than 81 years and not presenting with musculoskeletal problems/fractures. N = 349 (63.5%) were admitted from the ED. A significant multivariate predictor of in-hospital mortality was Charlson comorbidity index [CCI; odds ratio = 1.19, 95% confidence interval: 1.07, 1.34, P = 0.002]. Among patients who were discharged from ED without admission or after their first in-patient admission (N = 499), 232 (46.5%) re-attended ED within 1 year, with CCI being the best predictor of re-attendance (CCI ≤ 4: 25.8%, CCI > 5: 60.4%). Among N = 499, 34 (6.8%) had died after 1 year of initial ED presentation. The subgroup (N = 114) with the highest mortality (17.5%) was composed by those aged >77 years and brought in by ambulance on initial presentation.
  
  
  CONCLUSIONS
  Advanced age and comorbidity are important drivers of outcomes among older ED attendees. There is a need to embed specialist geriatric services within frontline services to make them more gerontologically attuned. Our results predate the opening of an acute medical unit with specialist geriatric input.
authors.affiliation: From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland sean.kennelly@amnch.ie.
authors.forename: S P
authors.initials: SP
authors.lastname: Kennelly
authors.affiliation: From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Drumm
authors.affiliation: From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland.
authors.forename: T
authors.initials: T
authors.lastname: Coughlan
authors.affiliation: From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Collins
authors.affiliation: From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O'Neill
authors.affiliation: From the Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Romero-Ortuno
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007494:Ireland; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D019233:Retreatment / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome