title: Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine.
abstract: BACKGROUND
  Frail older adults present to the Emergency Department (ED) with complex medical, functional, and social needs. When these needs can be addressed promptly, discharge is possible, and when they cannot, hospital admission is required. We evaluated the care needs of frail older adults in the ED who were consulted to internal medicine and seen by a geriatrician to determine, under current practices, which factors were associated with hospitalization and which allowed discharge.
  
  
  METHODS
  We preformed a chart-based, exploratory study. Data were abstracted from consultation records and ED charts. All cases had a standard Comprehensive Geriatric Assessment (CGA which records a Clinical Frailty Scale (CFA) and allows calculation of a Frailty Index (FI).
  
  
  RESULTS
  Of 100 consecutive patients, 2 died in the ED, 75 were admitted, and 23 were discharged, including one urgent placement. Compared with discharged patients (0.39 ± SD 0.16), those admitted had a higher mean FI-CGA (0.48 ± 0.13; p < .01). Greater mobility dependence (2% in discharged vs. 32% in admitted; p < .05) was notable.
  
  
  CONCLUSIONS
  Discharge decisions require assessment of medical, functional, and social problems. Ill, frail patients often can be discharged home when social and nursing support can be provided. The degree of frailty, impaired mobility, and likely delirium must be taken into account when planning for their care.
authors.affiliation: Geriatric Medicine Research Unit, Halifax, NS;; Capital District Health Authority, Halifax, NS;
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hominick
authors.affiliation: Geriatric Medicine Research Unit, Halifax, NS;
authors.forename: Victoria
authors.initials: V
authors.lastname: McLeod
authors.affiliation: Geriatric Medicine Research Unit, Halifax, NS;; Division of Geriatric Medicine, Dalhousie University, Halifax, NS.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
keywords: aged; delirium; emergency department; frail older adults; frailty index; geriatric assessment; hospital admission; hospital discharge; mobility impairment; social factors; social work