Characteristics of older adults admitted to the emergency department (ED) and their risk factors for ED readmission based on comprehensive geriatric assessment: a prospective cohort study.
BACKGROUND
Patients aged 75 years and older represent 12% of the overall emergency department (ED) population, and this proportion will increase over the next decades. Many of the discharged patients suffer an unplanned readmission in the immediate and midterm post-discharge period, suggesting under recognition of psychosocial, cognitive and medical problems. The aim of this study was to compare the characteristics of older patients admitted and discharged from the ED and to determine independent predictors for ED readmission 1 month and 3 months after ED discharge based on comprehensive geriatric assessment (CGA).


METHODS
Cohort study in a Belgian university hospital. A CGA, including demographic and medical data (e.g. reason for admission, comorbidity, number of medications), functional (e.g. activities of daily living, falls), mental (i.e. cognition, dementia, delirium), and nutritional status, and pain, was performed in 442 ED patients aged 75 years or older.


RESULTS
Patients discharged from the ED (n = 117, 26.5%) were significantly less dependent for ADL, mobility, shopping and finances compared with hospitalised patients. Hospitalised patients (n = 325, 73.5%) were significantly more at risk for having nutritional problems, had a higher comorbidity index, and a lower cognitive status compared with those discharged. Ninety-seven patients (82.9%) were discharged home from the ED. Of the latter, 18 (18.6%) and 28 patients (28.9%) suffered an ED readmission within 1 and 3 months, respectively. At one month post-discharge, nursing care at home, meals on wheels, and risk for depression; and at 3 months post-discharge previous hospitalisation in the last 3 months, physiotherapy and meals on wheels were found to be independent predictors for ED readmission, respectively.


CONCLUSIONS
This study observed a geriatric risk profile in older adults at the ED and a high readmission rate of those discharged, and suggests the potential value of CGA in identifying older patients at high risk for ED readmission.
Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium. Mieke.deschodt@kuleuven.be.|Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. Mieke.deschodt@kuleuven.be.
Mieke
M
Deschodt
Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium. els.devriendt@med.kuleuven.be.|Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. els.devriendt@med.kuleuven.be.
Els
E
Devriendt
Department of Public Health and Primary Care, Emergency Medicine, Kapucijnenvoer 35/4, 3000, Leuven, Belgium. Marc.sabbe@uzleuven.be.|Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. Marc.sabbe@uzleuven.be.
Marc
M
Sabbe
Department of Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. Daniel.knockaert@uzleuven.be.
Daniel
D
Knockaert
Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. Peter.deboutte@uzleuven.be.
Peter
P
Deboutte
Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. steven.boonen@uzleuven.be.
Steven
S
Boonen
Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. Johan.flamaing@uzleuven.be.
Johan
J
Flamaing
Department of Public Health and Primary Care, Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35/4, 3000, Leuven, Belgium. koen.milisen@med.kuleuven.be.|Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. koen.milisen@med.kuleuven.be.
Koen
K
Milisen
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D015897:Comorbidity; D003693:Delirium / Q000150:complications; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009752:Nutritional Status; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors