title: Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons.
abstract: OBJECTIVE
  Among older persons, disability and functional decline are associated with increased mortality, institutionalization, and costs. The aim of the study was to determine whether illnesses and injuries leading to an emergency department (ED) visit but not hospitalization are associated with functional decline among community-living older persons.
  
  
  METHODS
  From a cohort of 754 community-living older persons who have been followed with monthly interviews for up to 14 years, we matched 813 ED visits without hospitalization (ED only) to 813 observations without an ED visit or hospitalization (control). We compared the course of disability during the following 6 months between the 2 matched groups. To establish a frame of reference, we also compared the ED-only group with an unmatched group who were hospitalized after an ED visit (ED-hospitalized). Disability scores (range 0 [lowest] to 13 [highest]) were compared using generalized linear models adjusted for relevant covariates. Admission to a nursing home and mortality were evaluated as secondary outcomes.
  
  
  RESULTS
  The ED-only and control groups were well matched. For both groups, the mean age was 84 years, and 69% were women. The baseline disability scores were 3.4 and 3.6 in the ED-only and control groups, respectively. During the 6-month follow-up period, the ED-only group had significantly higher disability scores than the control group, with an adjusted risk ratio of 1.14 (95% confidence interval [CI] 1.09 to 1.19). Compared with participants in the ED-only group, those who were hospitalized after an ED visit had disability scores that were significantly higher (risk ratio 1.17; 95% CI 1.12 to 1.22). Both nursing home admissions (hazard ratio 3.11; 95% CI 2.05 to 4.72) and mortality (hazard ratio 1.93; 95% CI 1.07 to 3.49) were higher in the ED-only group versus control group during the 6-month follow-up period.
  
  
  CONCLUSIONS
  Although not as debilitating as an acute hospitalization, illnesses and injuries leading to an ED visit without hospitalization were associated with a clinically meaningful decline in functional status during the following 6 months, suggesting that the period after an ED visit represents a vulnerable time for community-living older persons.
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, CT. Electronic address: justine.nagurney@yale.edu.
authors.forename: Justine M
authors.initials: JM
authors.lastname: Nagurney
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT.
authors.forename: William
authors.initials: W
authors.lastname: Fleischman
authors.affiliation: Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT.
authors.forename: Ling
authors.initials: L
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT.
authors.forename: Linda
authors.initials: L
authors.lastname: Leo-Summers
authors.affiliation: Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Allore
authors.affiliation: Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*