title: Predictive factors for early unplanned rehospitalization of older adults after an ED visit: role of the caregiver burden.
abstract: OBJECTIVE
  For older adults, an Emergency Department (ED) visit represents a period of vulnerability that extends beyond the visit itself. This study aimed to determine the impact of the role of caregiver, and geriatric conditions of patients on early unplanned rehospitalization (EUR) within 3 months after an ED visit.
  
  
  METHODS
  This prospective longitudinal experimental study included consecutively 173 patients aged 75 and older admitted in an ED over a 2-week period (18.7% of the total visits). Only older patients having a caregiver were analyzed (78.0%, n = 135). Medical conditions and a comprehensive geriatric assessment were recorded for each patient. All caregivers were interviewed about their tasks and emotional impact using the short Zarit Burden Inventory. Three months after, patients or their caregivers were called about the vital status, and EUR of patients.
  
  
  RESULTS
  Among the patients included, 64.2% had an EUR and 28.9% of their caregivers reported a high level of burden. EUR was strongly associated with a high caregiver burden (OR 8.7, 95% CI 1.5-49.8). No association was found for patient's medical or geriatric status. Caregivers reported a significantly high burden when patients were malnourished, or were at risk of adverse health outcomes based on the ISAR scale, and when they had greater disabilities in IADLs and ADLs, or cognitive impairments.
  
  
  CONCLUSIONS
  Many hospital readmissions after an ED visit may be preventable by identifying caregiver's high burden. Reasons that lead to this high burden should be checked at the first visit.
authors.affiliation: Service de Médecine Interne Gériatrie, Hôpitaux Sud, Assistance Publique Hôpitaux de Marseille, Marseille, France.|Institut des Neurosciences Timone, UMR-CNRS 7289, Aix-Marseille Université, Marseille, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonin-Guillaume
authors.affiliation: Laboratoire de Santé Publique, EA 3279, Faculté de Médecine, Aix-Marseille Université, Marseille, France. anne-claire.durand@ap-hm.fr.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Durand
authors.affiliation: Laboratoire de Santé Publique, EA 3279, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Fadila
authors.initials: F
authors.lastname: Yahi
authors.affiliation: Laboratoire de Santé Publique, EA 3279, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Marielle
authors.initials: M
authors.lastname: Curiel-Berruyer
authors.affiliation: Unité Mobile de Gériatrie, Hôpital La Timone Adultes, Assistance Publique Hôpitaux de Marseille, Marseille, France.
authors.forename: Oceana
authors.initials: O
authors.lastname: Lacroix
authors.affiliation: Unité Mobile de Gériatrie, Hôpital La Timone Adultes, Assistance Publique Hôpitaux de Marseille, Marseille, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Cretel
authors.affiliation: Service d'Accueil des Urgences, Assistance Publique Hôpitaux de Marseille, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Alazia
authors.affiliation: Laboratoire de Santé Publique, EA 3279, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Sambuc
authors.affiliation: Laboratoire de Santé Publique, EA 3279, Faculté de Médecine, Aix-Marseille Université, Marseille, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gentile
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D005602:France; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies
keywords: Caregiver burden; Caregiving; Emergency department; Hospitalization; Older patient